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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802463
Report Date: 03/20/2023
Date Signed: 03/20/2023 05:07:52 PM

Document Has Been Signed on 03/20/2023 05:07 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:TANYA KRAMERFACILITY TYPE:
735
ADDRESS:3851 HOWE RDTELEPHONE:
(805) 398-5096
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY: 6CENSUS: 4DATE:
03/20/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:34 AM
MET WITH:Belen GutierrezTIME COMPLETED:
01:44 PM
NARRATIVE
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Licensing Program Analyst (LPA) Teresa Camara conducted an initial complaint visit regarding complaint control number 29-AS-20230317082841. LPA was joined by Tri-Counties Regional Center(TCRC) Quality Assurance Specialist (QAS) Liz Aced-Arnett.

During the complaint visit a deficiency was observed. LPA explained the reason for this report to interim administrator Belen Gutierrez.

Upon arrival to the facility there were three clients observed in the permanent side of the facility and one client observed in the crisis center side of the facility. There was one staff on the crisis center side and one staff on the permanent side. LPA and QAS reviewed this week's schedule and there is not enough staff scheduled to meet TCRC staffing requirements for this facility.

QAS stated the required staffing requirements for this facility is as follows:

If there are two or more clients on the permanent side of the facility there must be at least two staff on that side. On the crisis center side there must be one on one staff 24 hours for each client. In addition, there is one client on the permanent side of the facility who also requires 24 hour one on one care staff.

During the visit one more staff came to work, however they were still understaffed by one care staff.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited
(refer to LIC 809-D).

Exit interview conducted. Copy of the report and appeal rights given to administrator via email.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2023
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 03/20/2023 05:07 PM - It Cannot Be Edited


Created By: Teresa Camara On 03/20/2023 at 12:59 PM
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: 03/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/22/2023
Section Cited
CCR
85065.5

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85065.5 Day Staff-Client Ratio (a) Whenever a client who relies upon others to perform all activities of daily living is present, the following minimum staffing requirements shall be met: (1) For Regional Center clients, staffing shall be maintained as specified by the Regional Center but no less than one direct care staff to three such clients.
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Administrator will update the schedule with the required number of direct care staff on each shift and send the new schedule to CCL and TCRC by 3/22/2023 close of business.
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This requirement is not met as
evidenced by: Based on observation and records, the licensse did not comply with the section cited above as there were not enough staff working to meet TCRC staffing requirements, which poses a potential heatlh, safety and personal right risk to persons in care.
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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:Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME:Teresa Camara
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2023


LIC809 (FAS) - (06/04)
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