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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850071
Report Date: 09/17/2024
Date Signed: 09/20/2024 01:00:41 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
06/13/2024 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20240613103136
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:
09/17/2024
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Jolly PadayaoTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff are timing residents phone calls/visits
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Valeria Conway arrived at the facility to continue a subsequent complaint visit in reference to the above allegation. LPA met with Administrator, Jolly Padayo and informed her of the reason for today's visit.
It was alleged that the staff are timing resident’s phone calls and visits, as staff are restricting Resident #1 (R1s) telephone calls to five (5) minutes and only allows visitations for a short period of time.
During the initial investigation on 06/17/2024, LPA interviewed Administrator, Resident #1 (R1) and R1’s family member. LPA also gathered relevant records pertaining to this investigation. On 07/02/2024, LPA spoke to R1’s Deputy Public Guardian (DPG) and obtained Public Guardian court documents. On 07/03/2014, LPA and Quality Assurance Specialist (QAS), Ryan Landseadel, from Tri-Counties Regional Center interviewed Administrator.

Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
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-20240613103136
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CARE FOR PEOPLE
FACILITY NUMBER: 565850071
VISIT DATE: 09/17/2024
NARRATIVE
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Continued from LIC 9099

Based on the information obtained during this investigation, Administrator was advised by DPG, not to allow physical visitation unless R1 has a prior approval form DPG and Administrator.

Additionally, Administrator stated that facility is following PG advise to have. R1’s visitors, to fill out a visitation form named PG – Client Leave Request that shall be approved by DPG before visitation. Furthermore, evidence shows that R1 was only able to have supervised phone calls between 4-5 P.M. In the case, R1 has a behavior episode during a telephone call, Administrator will terminate communication for R1s wellbeing. However, court documents reviewed did not indicate that R1’s conservator had the authority to restrict R1’s visitation or telephone calls.

A discussion was held between the parties that if the facility/conservator feels like R1 is having behavior episodes due to certain visitors they would need to get the court documentation updated to reflect that the conservator has the legal authority to make such decisions.

Based on the information gathered during the course of the investigation, the Department has sufficient evidence to determine that R1's personal right to receive visitors and private telephone calls were violated. Therefore, the above allegation “staff are timing resident’s phone calls and visits” is deemed SUBSTANTIATED at this time.

Exit interview conducted and report issued with deficiency. Appeal Right given.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20240613103136
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CARE FOR PEOPLE
FACILITY NUMBER: 565850071
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
10/01/2024
Section Cited
CCR
85072(b)(4)
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85072(b)(4) Personal Rights. Each resident shall have the right to have visitors, including advocacy representatives, visit privately during waking hours, provided that such visitations do not infringe upon the rights of other clients. This requirement is not met as evidenced by…
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License will contact public guardian to ensure the contents of the court order. In the mean while Licensee will stop using form given by Public Guardian to schedule visitations.
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Based on interviews and record review, licensee failed to comply with the above section by restricting R1s phone calls and visitation, which a potential personal rights risk to resident in care.
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Also, Licensee shall submit the declaration stating that licensee understand the clients Personal Rights regulations regarding under code section 80072 and will comply with the regulation.
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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: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
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