<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802463
Report Date: 12/13/2023
Date Signed: 12/13/2023 02:30:03 PM

Document Has Been Signed on 12/13/2023 02:30 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:PEOPLE'S CARE HOWEFACILITY NUMBER:
565802463
ADMINISTRATOR:DANSHELLE DAYFACILITY TYPE:
735
ADDRESS:3851 HOWE RDTELEPHONE:
(805) 398-5096
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY: 6CENSUS: 4DATE:
12/13/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Danshelle DayTIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Teresa Camara conducted an unannounced required annual continuation visit to the above facility. LPA met with administrator Danshelle Day and explained the reason for the visit.

During LPA's visit on 9/27/2023, LPA conducted the physical plant inspection and no health and safety hazards or deficiencies were observed. Today's annual continuation visit focused on documentation in staff and client files. LPA interviewed two clients and two staff; no concerns were noted.

CLIENT RECORDS: Four (4) client files were reviewed. All documentation reviewed was found complete and in each client's file. In addition, LPA reviewed medications and the centrally stored medication and destruction records. Medications appear to be given as prescribed.

STAFF RECORDS: Five (5) staff files were reviewed. All documentation was found complete and in each staff's file.

DISASTER PLAN: LPA reviewed the facility's disaster plan which appeared complete. The Administrator will ensure it is kept updated as needed and review the information at minimum annually. The facility conducts disaster drills on each shift monthly.


No citations were issued during today’s visit. Exit interview conducted. A copy of the report was provided to the Administrator.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1