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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850071
Report Date: 01/13/2023
Date Signed: 01/13/2023 05:11:02 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
01/05/2023 and conducted by Evaluator Teresa Camara
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20230105090752
FACILITY NAME:CARE FOR PEOPLEFACILITY NUMBER:
565850071
ADMINISTRATOR:JOLLY PADAYAOFACILITY TYPE:
735
ADDRESS:1545 CHURCH STREETTELEPHONE:
(805) 285-0619
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:4CENSUS: 3DATE:
01/13/2023
UNANNOUNCEDTIME BEGAN:
01:37 PM
MET WITH:Jolly PadayaoTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Resident's medical needs are not being met.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Teresa Camara conducted an intial complaint visit at the facility. LPA was joined by Tri-Counties Regional Center Quality Assurance Specialist (QAS) Ryan Landseadel. LPA and QAS met with administrator Jolly Padayao.

LPA and QAS conducted a brief facility tour at 1:45 p.m. LPA and QAS conducted interviews with staff starting at 2:00 p.m. LPA and QAS reviewed and obtained pertinent records at 2:35 p.m. According to records Resident 1 (R1) suffered from right thumb pain approximately 15 months ago and was told by a physician to use acetaminophen for pain, ice the thumb and wear a thumb splint. According to staff, the thumb pain eventually went away. On or about 1/5/2023, R1 complained of right thumb pain again. Ice was applied and R1 was given prn medication (acetaminophen) for pain. On 1/6/2023, R1 continued to complain of thumb pain so Staff 1 (S1) offered to give R1 a ride to the urgent care at approximately 5:00-6:00 p.m. R1 refused to go to

(continued on 9099-c)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023
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-20230105090752
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: CARE FOR PEOPLE
FACILITY NUMBER: 565850071
VISIT DATE: 01/13/2023
NARRATIVE
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(continued from 9099)

the urgent care and said they were doing ok. At that time, R1 was busy packing their belongings as they were moving out of the facility. On 1/7/2023, Staff 2 (S2) assisted R1 in purchasing a thumb splint on Amazon which arrived that evening. On 1/8/2023, R1 moved out of the facility and is now living independently. Attempts to reach R1 have been unsuccessful.

Based on information obtained during this visit, the above noted allegation that R1's medical needs were not being met are deemed Unsubstantiated at this time. Exit interview conducted and a copy of the report was emailed to the administrator.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2