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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 567609712
Report Date: 04/28/2021
Date Signed: 04/28/2021 10:18:20 AM

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:BERNADETTE HOME CARE IIFACILITY NUMBER:
567609712
ADMINISTRATOR:ABIERA, BERNADETTEFACILITY TYPE:
740
ADDRESS:1982 LATHAN AVETELEPHONE:
(805) 437-6302
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:6CENSUS: 6DATE:
04/28/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Bernadette Abiera and Janette VillapandoTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Aja Richardson initiated a Case Management - Incident visit. The purpose of this visit is to conduct an investigation regarding an incident report received at the Woodland Hills North Regional Office on 4/26/21. LPA met with the Administrator Bernadette Abiera and assistant Administrator Janette Villapando at 8:35 am and explained the reason for the visit.

According to the incident report, on 4/25/2021, the Administrator received notification from a relative of Resident #1 (R1's) who visited R1 at the facility on 4/25/21 at approximately 11 am, and alleged inappropriate touching by facility staff.

During today's visit, LPA RIchardson toured the facility at 8:35 am and conducted interviews from 8:45 am to 9:45 am. LPA conducted interviews with the Administrator, Assistant Administrator, staff, R1, other residents in care, and R1's relative.

At this time additional investigation is needed.

Exit Interview Conducted. Report Emailed to the Administrator.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja RichardsonTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2021
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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