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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802463
Report Date: 10/28/2024
Date Signed: 10/28/2024 04:17:20 PM

Document Has Been Signed on 10/28/2024 04:17 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:PEOPLE'S CARE HOWEFACILITY NUMBER:
565802463
ADMINISTRATOR/
DIRECTOR:		DANSHELLE DAYFACILITY TYPE:
735
ADDRESS:3851 HOWE RDTELEPHONE:
(805) 398-5096
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY: 6CENSUS: 4DATE:
10/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:42 PM
MET WITH:Danshelle DayTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Kelly Dulek conducted a Case Management - Incident visit regarding a self-reported incident that occurred on 07/01/2024. LPA attempted an initial visit on 07/12/2024 at 10:00AM, however no clients nor staff were present. LPA returned today to continue the visit. LPA met with administrator Danshelle Day and explained the reason for the visit.

The incident report indicates that on 07/01/2024, Client #1 (C1) made an allegation that staff choked C1. Facility staff and administrator interviewed C1 and staff related to the allegation and documentation of interviews was provided to Community Care Licensing. C1 admitted to staff that C1's father told C1 to make the allegation and that this never happened. During today's visit, LPA interviewed C1, who answered most of the LPA's questions, but C1 kept changing the subject and did not talk about the allegation. LPA reviewed staff records and at the time of the allegation, nor prior to the allegation did any staff work here with the name indicated in the initial allegation.

Should further investigation be warranted, LPA will return at a later date. No deficiencies were observed. Exit interview conducted and report issued.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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