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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850071
Report Date: 08/15/2024
Date Signed: 08/15/2024 09:39:04 AM

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
07/15/2024 and conducted by Evaluator Martha Arroyo
COMPLAINT CONTROL NUMBER: 29-AS-20240715082211
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: 4DATE:
08/15/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jolly PadayaoTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Due to lack of supervision, resident is being assaulted by another resident.
Staff are not notifying authorized representative of incidents.
Staff are not providing adequate food for resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegations. The initial visit was conducted on 07/19/2024 by LPA M. Arroyo. On today's visit, LPA Arroyo met with Administrator, Jolly Padayao. Entrance interview.

During the initial visit on 07/19/2024, LPA Arroyo conducted a plant tour at 9:30 a.m., observed the kitchen and food service area at 9:34 a.m., conducted interviews with the Administrator, three (3) staff members and two (2) resident between 9:15 a.m. and 1:10 p.m., conducted a file review at 11:00 a.m., and obtained copies of pertinent documents.

Report Continued on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
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 3
Control Number 29-AS-20240715082211
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: 08/15/2024
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...

It was alleged that due to lack of supervision, resident is being assaulted by another resident. The complainant’s concern is that while staff leave the room or go to use the restroom, Resident #1 (R1) is being attacked by Resident #1 (R2). It was reported that R2 pulled a knife on R1, and the police were contacted. Record review of facility’s incident reports revealed that the facility had an incident where R2 called 911, reported having suicidal ideations, and threatened to hurt themselves. Interviews conducted with staff revealed that R2 contacted 911 themselves and claimed to have a knife to hurt themselves. Staff stated that R2 never had a knife in their possession and were not near any other residents at the facility at any time during the incident. Staff also stated that if they need to step away at any time, there are other staff available to watch R2 and the other residents. During an interview conducted with R1, R1 stated that R2 claimed to have had a knife, but they never had one. Additionally, R1 stated that R2 never came to close them or the other residents at the home and added that staff is always around supervising R2 as well as the other residents. Furthermore, during resident interviews, residents stated that they felt safe living at the facility and had no concerns. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “due to lack of supervision, resident is being assaulted by another resident”. Therefore, this allegation is being deemed Unsubstantiated at this time.

It was also alleged that staff are not notifying authorized representative of incidents. It was reported that the facility is not notifying the resident’s responsible person when there are incidents that have occurred. Records reviewed revealed that the Administrator is submitting incident reports to the Department within the seven (7) days of occurrence. Records reviewed also revealed that the Administrator is notifying the resident’s responsible person via email which includes a copy of the incident report submitted to the Department. Interviews conducted with the Administrator and facility staff revealed that the Administrator also contacts the resident’s responsible person via telephone call. Staff stated that they document all incidents that occur at the facility and report to the Administrator. The Administrator then notifies all the necessary parties after they have all the information together. Interviews conducted with residents revealed that staff notifies their responsible person and keeps them up to date with what is happening at the facility. Based on records reviewed and interviews conducted with facility staff and residents, the Department does not have sufficient evidence to support the allegation of “staff are not notifying authorized representative of incident”. Therefore, this allegation is being deemed Unsubstantiated at this time.

Report Continued on LIC 9099C...

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20240715082211
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: 08/15/2024
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 9099C...

It was further alleged that staff are not providing adequate food for resident. The complainant’s concern is that facility staff are not preparing adequate food for R1’s school lunches. During the visit on 07/19/2024, the LPA observed the kitchen and food supply. The facility had a variety of food including fruits, vegetables, milk, meats, eggs, and bread. Interview conducted with the Administrator revealed that the facility has an inventory of all the foods available and if they are running low, the staff will send the Administrator a message to let them know to bring additional food. Interviews conducted with residents revealed that facility provides all three meals, breakfast, lunch, dinner, and snacks in between the meals. During an interview with R1, R1 stated that staff was packing their lunch while they were attending school. R1 stated that the food at school was not very healthy; therefore, the staff started packing their lunch and snacks instead. R1 added that the staff make a really good salad they enjoyed every day and that on Friday’s they would have pizza. R1 also stated that they are given a snack as soon as they get home from school every day. Furthermore, residents reported that the food prepared by staff was good and had no concerns living at the facility. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “staff are not providing adequate food for resident”. Therefore, this allegation is being deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. Report was reviewed and a copy was provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3