<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850062
Report Date: 07/15/2024
Date Signed: 07/15/2024 01:46:54 PM

Document Has Been Signed on 07/15/2024 01:46 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: 33DATE:
07/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Jesus CardenasTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced case management visit at 1:20 p.m. The purpose of this visit is to conclude an investigation regarding an incident that occurred on 04/30/2024. 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 the initial visit on 05/10/2024, LPA Arroyo 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. On 06/21/2024, LPA Arroyo conducted a telephonic interview with a staff member at 3:08 p.m.

Interviews conducted with staff revealed that I1 and S1 had not been working together at the day program for too long. Staff stated that lately the rotation between I1 and S1 was not constant as they were trying to find a staff that worked well with I1. Regarding the incident, interviews conducted with staff revealed that S1 worked well with the individuals that S1 was assigned to while they worked together. Staff added that S1 was consistent with all individuals and did not show favoritism, which is what is thought to be the reason I1 may have made the comment to their responsible person. Interviews also revealed that I1 did not seem “happy” while working together with S1.



Report Continued on LIC 809C...
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2024
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 VALLEY
FACILITY NUMBER: 565850062
VISIT DATE: 07/15/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Report Continued from LIC 809...

During an interview with I1, I1 was asked about the incident with S1. However, due to I1’s inconsistency with their statements, LPA was unable to determine what S1 had said to I1. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies cited. Exit interview conducted. Copy of the report was provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2