565802463-8-2-2022-29-AS-KHEN-CHSSGG-20220830135154

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802463
Report Date: 08/02/2022
Date Signed: 08/02/2022 04:58:16 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/07/2020 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20200707152230

FACILITY NAME:	PEOPLE'S CARE HOWE		FACILITY NUMBER:	565802463
ADMINISTRATOR:	SHAWN BAILEY		FACILITY TYPE:	735
ADDRESS:	3851 HOWE RD		TELEPHONE:	(805) 398-5096
CITY:	FILLMORE	STATE: CA	ZIP CODE:	93015
CAPACITY:	6	CENSUS: 5	DATE:	08/02/2022
		UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Belen Gutierrez		TIME COMPLETED:	03:23 PM

ALLEGATION(S):

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Lack of supervision resulted in resident getting hit by another resident
Staff member accused resident of lying

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint inspection with the purpose of delivering findings for the allegations listed above. LPA arrived at the facility at 11:55AM and initially met with facility staff Tiana Viveros. Staff indicated Administrator Carlos Marcia was unavailable for today's visit; LPA spoke with Administrator at 01:17PM and confirmed House Lead is authorized to sign reports for the facility. House Lead Belen Gutierrez arrived at the facility at 01:30PM. Entrance interview conducted.

During today’s visit, LPA and facilty staff Tiana toured the facility at 11:58AM. No health and safety hazards were identified during facility tour. Previously, on 07/16/2020, LPA Dulek and Tri-Counties Regional Center Quality Assurance Specialist (QA) Liz Aced-Arnett conducted a telephone interview with the administrator Shawn Bailey at 1:53PM. The LPA also requested copies of pertinent documents. Then, on various dates throughout the course of the investigation, LPA and QA Liz Aced-Arnett conducted telephone interviews with
Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20200707152230

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 HOWE	FACILITY NUMBER: 565802463
	VISIT DATE: 08/02/2022

NARRATIVE

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staff members and clients. LPA also reviewed pertinent documents. The following was then determined:

Regarding the allegation “lack of supervision resulted in resident getting hit by another resident:”

Interview revealed that Client 1 (C1) indicated Client 2 (C2) had hit them on the back while both clients were outside. C1 indicated staff were not present at the time of the incident. C1 indicated there were bruises on their back but did not wish to show them to LPA and QA. During an interview, C2 denied any physical altercation with C1 on or around the date in question. No additional clients interviewed, nor staff witnessed the alleged incident. Staff interview revealed that on 07/27/2020, C1 recanted the allegation and authored a letter indicating C2 had not hit them in the back. Record review and interview revealed that C1 instigates C2, but that C2 does not engage with physical altercations with C1. C1 indicated there were no staff present during the time of the incident and that C1 was outside on the patio smoking when the incident occurred. Staff interview revealed that C1 is in line of sight of the staff at all times while C1 is outside smoking and C2 was outside chasing butterflies at the time of the allegation. Record review revealed sufficient staff scheduled at the time of the alleged incident. Although the allegation may be valid, at this time there is insufficient evidence to prove a violation occurred, therefore based on interview and record review, the allegation that “lack of supervision resulted in resident getting hit by another resident” is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “staff member accused resident of lying:”

Interview with C1 revealed that when C1 reported the alleged incident to Administrator Shawn Bailey, the Administrator and Staff #1 (S1) reviewed camera footage. Administrator didn’t see anything questionable on the camera and then stated to C1 they were lying about the incident. Staff interview revealed that staff and other clients were present when Administrator stated C1 was lying. C1 then admitted they were lying and wrote a letter indicating the alleged incident did not occur. Administrator interview indicated yes, she stated C1 was lying. Although Administrator did admit to making a statement indicating C1 was lying, C1 did admit to lying and did not feel their personal rights were violated based on this statement. C1 indicated they feel safe in the home and said that they were lying about this incident. Based on interview, although the allegation may be valid, at this time there is insufficient evidence to prove a violation occurred, therefore the allegation that “staff member accused resident of lying” is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted. A copy of the report was provided via email.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

LIC9099 (FAS) - (06/04)

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