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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850062
Report Date: 05/10/2024
Date Signed: 05/10/2024 02:26:27 PM

Document Has Been Signed on 05/10/2024 02:26 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:COLE VOCATIONAL SERVICES - SIMI VALLEYFACILITY NUMBER:
565850062
ADMINISTRATOR/
DIRECTOR:		CONK, SUSANFACILITY TYPE:
775
ADDRESS:660 EAST LOS ANGELES AVE UNT LTELEPHONE:
(805) 479-2604
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 45CENSUS: 32DATE:
05/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Jesus CardenasTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced Case Management – Incident visit today for the purpose of investigating a self-reported incident report and SOC 341. Upon arrival, LPA met with Program Manager, Jesus Cardenas and the reason for the visit was explained. Entrance interview.

On 05/02/2024, the Department received an incident report stating that on 04/30/2024, Individual #1 (I1) told I1’s father that Staff #1 (S1) told I1 to,” shut up and be quiet and listen to me read you the bible”. According to I1’s father, I1 stated that I1 does not feel comfortable speaking up, so I1’s father brought it up to the Program Supervisor on 05/01/2024.

During today’s visit, LPA conducted interviews with three (3) staff members and one (1) individual between 1:10 p.m. and 1:45 p.m., conducted a resident file review at 1:55 p.m., and obtained copies of pertinent documents relevant to the investigation. LPA has determined further investigation is needed and will return at a later date to continue.

Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2024
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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