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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802463
Report Date: 05/29/2024
Date Signed: 05/29/2024 10:48:59 AM

Document Has Been Signed on 05/29/2024 10:48 AM - 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:
05/29/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:06 AM
MET WITH:Danshelle DayTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced Case Management Deficiency visit in conjunction with complaint visit (CC #29-AS-20230130113402). LPA met with Administrator, Danshelle Day. The purpose of this visit is to issue citations for deficiencies observed during the complaint investigation which were not related to the complaint allegations.

The investigation revealed that staff member(s) “have known” of C1 and C2’s inappropriate and sexual behavior(s) “for a while” since October 2022. The staff observed some inappropriate interactions between C1 and C2 and elevated their observations to supervisors. Staff indicated that the sexual encounters appeared to have been consensual. Staff member(s) admitted to witnessing the inappropriate behavior(s) between C1 and C2 and had only been redirecting the behavior(s); but “never reported or documented any of the incidents” until January 2023.

In January 2023, there were two separate incidents that occurred on 01/11/2023 and 01/23/2023, of which staff member(s) witnessed C1 and C2 engage in sexual behaviors and tendencies. Staff #1 (S1) and Staff #2 (S2) reported these incidents to upper management, but never documented or reported (to CCL, APS, police, or C1’s resident representative) until 01/29/2023 in a Special Incident Report (SIR).

Citation issued, exit interview, appeal rights given.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 05/29/2024 10:49 AM - It Cannot Be Edited


Created By: Martha Arroyo On 05/29/2024 at 10:07 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: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/29/2024
Section Cited
CCR
80061(a)(b)(E)(c)

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(a) Each licensee shall furnish (b)Upon the occurrence, during the operation of the facility...within the agency's next working day during its normal business hours the local law enforcement agency within two (2) hours as required by Welfare and Institutions Code Section 15630(b)(1). This requirement is not met as evidenced by:
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The licensee was previously cited on 05/09/2023 for reporting requirements 80061(a)(b)(E)(c). The licensee conducted staff training on reporting requirements including suspected dependent adult abuse reporting. The plan of correction is complete.
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Based on interviews and records review, the licensee did not comply with the section cited above. Staff observed inappropriate and sexual behaviors between C1 and C2 and did not submit incident reports, SOC341 Suspected Dependent Adult Abuse form, contact police, or communicate to C1’s resident representative, which posed a potential health and safety risk to residents in care.
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Type B
06/03/2024
Section Cited
CCR85068.3(a)

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(a)The written Needs and Services Plan specified in Section 85068.2 shall be updated as frequently as necessary to ensure its accuracy, and to document significant occurrences that result in changes in the client's physical, mental and/or social functioning. This requirement is not met as evidenced by:
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The licensee will submit plan how you will ensure the Needs and Services Plan will be updated to reflect significant changes and needs of the clients, in order to provide appropriate care and supervision. Submit to CCL by 06/03/2024.
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Based on interviews and records review, the licensee did not comply with the section cited above. Facility staff observed inappropriate and sexual behaviors between C1 and C2 and did not initiate an action plan for appropriate care and supervision, which posed a potential health and safety risk to residents 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:Desaree Perera
LICENSING EVALUATOR NAME:Martha Arroyo
LICENSING EVALUATOR SIGNATURE:
DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2024


LIC809 (FAS) - (06/04)
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