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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802463
Report Date: 08/02/2022
Date Signed: 08/02/2022 04:49:35 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
08/25/2020 and conducted by Evaluator Kelly Dulek
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20200825163146
FACILITY NAME:PEOPLE'S CARE HOWEFACILITY NUMBER:
565802463
ADMINISTRATOR:SHAWN BAILEYFACILITY TYPE:
735
ADDRESS:3851 HOWE RDTELEPHONE:
(805) 398-5096
CITY:FILLMORESTATE: CAZIP CODE:
93015
CAPACITY:6CENSUS: 5DATE:
08/02/2022
UNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Belen GutierrezTIME COMPLETED:
03:23 PM
ALLEGATION(S):
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Staff abandoned residents
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 facility staff Tiana Viveros toured the facility at 11:58AM. No health and safety hazards were identified during facility tour. Previously, on 08/26/2020, LPA Dulek and Tri-Counties Regional Center Quality Assurance Specialist (QA) Liz Aced-Arnett conducted a telephone interview with the administrator at 11:27AM. LPA requested copies of Resident #1 (R1)’s pertinent documents. Then, on various dates throughout the course of the investigation, LPA and QA Liz Aced-Arnett conducted telephone interviews
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)
Page: 1 of 2
Control Number 29-AS-20200825163146
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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with staff members, and clients. LPA also reviewed pertinent documents. The following was then determined:

Regarding the allegation that “staff abandoned residents,” record review revealed that Client 1 (C1) moved into the facility on 08/22/2020. C1 was then involved in multiple incidents on 08/23/2020, where law enforcement was called. C1 resisted law enforcement contact, although law enforcement determined C1 needed to be taken on a 5150 hold. C1 acquiesced and law enforcement transported C1 to the local hospital. Facility management then contacted CCLD and a collaborative meeting was held on 08/24/2020 in regard to C1’s placement at the facility and the steps to follow should C1 need to be lawfully evicted. At that time, C1 was on a 72 hour hold at the hospital. Due to COVID safety precautions, C1 returned to the facility on 08/27/2020. LPA confirmed virtually that C1 was present in the facility during a virtual visit on 09/15/2020. Therefore, based on record review, interview, and observation, the allegation that “staff abandoned residents” 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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