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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802463
Report Date: 11/04/2022
Date Signed: 11/04/2022 03:26:25 PM

Substantiated


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
10/25/2022 and conducted by Evaluator Angel Ascencio
COMPLAINT CONTROL NUMBER: 29-AS-20221025104736
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:
11/04/2022
UNANNOUNCEDTIME BEGAN:
09:23 AM
MET WITH:Tanya KramerTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Facility lights are in disrepair
Staff do not treat resident with respect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angel Ascencio conducted an initial complaint visit to the above facility. LPA met with House Lead Belen Gutierrez at 9:23 a.m. Administrator Tanya Kramer arrived at the facility at 11:00 a.m. Entrance interview conducted.

On 10/25/2022, the Department received a complaint regarding facility lights are in disrepair and staff do not treat resiednts with respect. On 10/18/2022, LPA Ascencio conducted an Annual visit to the facility. LPA observed flood lights unlatched on the outside of the home and multiple light switches broken within the home. House Lead stated that they have sent out previous work orders for repair back in 08/03/2022 and a follow up work order on 10/10/2022. LPA received the work order request that were sent. LPA stated to get the repairs fixed as soon as possible. On 11/4/2022, LPA conducted a facility tour at 9:28 a.m, and observed light switches and flood lights in non-working, broken condition.

Continued on LIC 9099 - C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
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 5
Control Number 29-AS-20221025104736
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: 11/04/2022
NARRATIVE
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Admin Kramer stated that there has been some work done but other work needed are processing slowly, more is still in need. Based on observation and documents received, the allegation facility lights are in disrepair is Substantiated at this time.

Regarding staff do not treat resident with respect. On 10/25/2022, starting at 12:00 p.m.,LPA Ascencio, LPA Kelly Dulek, Tri-Counties Regional Center Quality Assurance Specialist (QA) LIz Aced-Arnett and People's Care Representatives Abe Avilla, Tanya Kramer and Christopher Trevilla conducted a conference call regarding Resident #1's (R1) cigarettes being lock up. QA stated that there was a behavioral issue with R1. R1 wanted to have cigarettes but staff were denying R1 access to them. QA Liz stated R1 being denied their cigarettes or R1's cigarettes being locked up is a violation to their personal rights and it should stop. QA also stated that Tri-County Regional Center was going to issue their own substantiated report for the incident. On 11/4/2022, interview with staff, starting at 9:46 a.m., revealed that R1 is limited on cash resources and therefore limited on the amount of cigarettes they can have each day by staff. Further interview with staff also revealed that, in October, the office was locked and keys went missing. Staff did not have access to the office, which contained R1's cigarettes. Staff also stated that if they dont limit R1's cigarette intake, R1 will smoke the entire pack, and when R1 runs out of packets, challenging behaviors are presented. That same day, LPA Ascencio conducted interview with R1 starting at 10:10 a.m. R1 stated that a few weeks ago, there was an issue with R1 not receiving their cigarettes. R1 added the cigarettes are in the office space, in a drawer. R1 continued, at one point in time, the office was locked up and R1 could not get any cigarettes. R1 added that they became very upset when they could not have the cigarettes as R1 is paying for them. Based on interviews, the allegation Staff do not treat resident with respect is deemed substantiated at this time.


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 admin via email.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20221025104736
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/07/2022
Section Cited
CCR
80072(a)(2)
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80072 Personal RIghts (a)(2) To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement is not met as
evidenced by:
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Admin will conduct all staff training in the regualtion 80072 (a)(2). Admin will provide training material and attendees to LPA.
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Based on interviews and conference call, the licensee did not comply with the section cited above as facility staff locked up and denied R1 from having cigarettes which poses an immidiate health, 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.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20221025104736
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/18/2022
Section Cited
CCR
80087(a)
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80087 Building and Grounds
The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as
evidenced by:
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Admin will repair all light switches and flood lights. Admin will take pictures of the repair and work order completed to LPA.
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Based on observation and records, teh licensse did not comply with tehe section cited above as the flood lights and light switches are in non-operable condition 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.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5