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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 567609712
Report Date: 08/04/2021
Date Signed: 08/04/2021 09:57:44 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:
08/04/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Bernadette Abiera, AdministratorTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Salia Walker conducted an unannounced Case Management - Incident visit today to deliver the final report regarding an incident report that was received at the Woodland Hills North Regional Office on April 26, 2021. During today’s visit, LPA Walker met with Bernadette Abiera at 09:15 a.m. and explained the reason for the visit. Upon arrival, the LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards.

On April 26, 2021, the facility self-reported an incident which described the administrator receiving notification from a relative of Resident #1 (R1) who visited R1 at the facility on April 25, 2021 and alleged inappropriate touching by facility staff which resulted in the relative taking R1 to the Hospital, R1 being assessed by medical professionals and also interviewed by Law Enforcement.
On April 28, 2021, Licensing Program Analyst (LPA) Aja Richardson initiated a Case Management-Incident visit to investigate the self-reported incident. Between 8:45 a.m. and 9:45 a.m., LPA Richardson conducted interviews with R1, R1’s relative, the Administrator, Assistant Administrator, Staff, and other residents in care. Resident interviews revealed that they felt comfortable in the home, that the staff are nice and they feel safe. The facility staff denied that they inappropriately touched anyone. It was revealed that R1 believed that twenty-five (25) year old boys who R1 worked with in the past allegedly inappropriately touched R1. R1 is diagnosed with dementia and R1’s family speculated that this must have been something that happened to R1 a long time ago, and R1 happened to remember it now.

Therefore, based on the supportive documents, interviews, and R1’s relative retracting the allegation, there is insufficient evidence to suggest that R1 was touched inappropriately by facility staff.
No deficiencies cited.
Exit Interview conducted. A copy of the report was issued.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021
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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