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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802463
Report Date: 04/22/2022
Date Signed: 04/22/2022 03:29:42 PM

Document Has Been Signed on 04/22/2022 03:29 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:CARLOS MARCIAFACILITY TYPE:
735
ADDRESS:3851 HOWE RDTELEPHONE:
(805) 398-5096
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY: 6CENSUS: 5DATE:
04/22/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Carlos MarciaTIME COMPLETED:
12:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Angel Ascencio conducted a Case Management-Deficiency visit regarding an incident report that was received on 04/08/22 regarding an inappropriate touching between two clients that occurred on 04/06/22. LPA Ascencio met with Administrator Carlos Marcia.

On 04/08/22, LPA Ascencio received an incident regarding an inappropriate touching between two clients. Admin Marcia communicated with Quality Assurance Specialist (QA) Liz Arced-Arnett and LPA Ascencio via telephone call on 04/07/2022. Interview with Admin on 04/11/22 revealed that law enforcement was called more than 24 hours after incident had happened, on 4/08/22.

Although the facility did notify CCL and TCRC on 4/7/22 of the 4/6/22 incident, the facility failed to notify law enforcement until 4/8/22 which does not follow the mandated reporting requirements 24 hour incident.

Therefore, the following deficiency was observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties.



Exit interview conducted. A copy of the report and appeal rights were provided via email.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2022
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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Document Has Been Signed on 04/22/2022 03:29 PM - It Cannot Be Edited


Created By: Angel Ascencio On 04/22/2022 at 10:42 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PEOPLE'S CARE HOWE
FACILITY NUMBER: 565802463

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/25/2022
Section Cited
CCR
80061(d)

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80061 Reporting Requirements (d) Any suspected physical abuse that does not result in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within twenty-four (24) hours as required by Welfare and Institutions Code Section 15630(b)(1).
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Admin stated that they will conduct training with all staff regarding mandated reporting from on outside agency. Admin will submit all documentation, including attendees to LPA via email.
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Based on evidence and interviews gathered, the licensee did not comply with the section cited above as the local law enforecement agency was not called within twenty-four hours after knowing of any suspected physical abuse of an adult.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kristin Heffernan
LICENSING EVALUATOR NAME:Angel Ascencio
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2022


LIC809 (FAS) - (06/04)
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