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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 04:17:57 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:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Danshelle DayTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced required annual visit to the above facility. LPA arrived at 01:00PM and met with facility staff. Administrator Danshelle Day arrived at 01:42PM. LPA met with administrator Danshelle Day and explained the reason for the visit.

At 01:44PM, LPA conducted a tour of the physical plant areas inside and outside to ensure there are no health and safety hazards. This home is vendor by Tri-Counties Regional Center as a level 4i home.

BEDROOMS: There are 6 (six) client bedrooms; 4 (four) rooms on the permanent side and two rooms on the crisis side. All rooms were clean, appropriately furnished and had sufficient lighting.

RESTROOMS: There are four (4) total bathrooms at the home. One (1) is designated as a staff bathroom and is located next to the administrator's office. The medications are stored in locked cabinets inside the locked staff bathroom. One (1) bathroom is located on the crisis side of the facility. Two additional bathrooms are located on the permanent side. All bathrooms were clean and the client bathrooms had non-skid materials and grab bars. Hot water tested at 110.0 degrees Fahrenheit. Cleaning supplies are stored in a locked closet next to the laundry room.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common hallway. Fire extinguishers were observed to be fully charged and are scheduled for inspection on 10/29/2024. Smoke and carbon monoxide alarms were tested at 03:22PM and functioned properly. The garage was locked. There was an emergency food supply and emergency water inside the house. Additional food supplies were observed in the garage and laundry room. The backyard has a covered outdoor area equipped with furniture for client use. There were no bodies of water noted.

Report Continued on LIC 809-C

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 10/28/2024
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KITCHEN: Kitchen knives are stored in a locked cabinet in the kitchen. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of perishable and nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. No flies or other vermin were observed

CLIENT RECORDS: Four (4) client files were reviewed. All documentation reviewed was found complete and in each client's file. P&I records were maintained for each client and were accurate.

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

INFECTION CONTROL/EMERGENCY DISASTER PLAN: LPA reviewed both the facility's infection control plan and the disaster plan, both of which appeared complete and updated annually as required. The facility conducts disaster drills on each shift monthly, with the last documented drill on 09/24/2024.

MEDICATIONS: LPA reviewed medications and the centrally stored medication and destruction records. Medications appear to be given as prescribed.

INTERVIEWS: During today's visit, LPA interviewed 1 (one) client and 2 (two) staff. No concerns were noted.

No citations were issued during today’s visit. Exit interview conducted. A copy of the report was provided to the Administrator.

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
LIC809 (FAS) - (06/04)
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