567609849-8-20-2023-29-AS-DPEA-D2UTJU-20240227134657

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609849
Report Date: 08/18/2023
Date Signed: 08/20/2023 08:54:01 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
08/16/2023 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20230816091820

FACILITY NAME:	PCS - FERNWOOD		FACILITY NUMBER:	567609849
ADMINISTRATOR:	DANIEL, DADESII		FACILITY TYPE:	735
ADDRESS:	515 FERNWOOD DR		TELEPHONE:	(805) 307-1810
CITY:	OXNARD	STATE: CA	ZIP CODE:	93030
CAPACITY:	4	CENSUS: 4	DATE:	08/18/2023
		UNANNOUNCED	TIME BEGAN:	11:16 AM
MET WITH:	Dadesii "DiDi" Daniel		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff failed to report client's adverse reaction to medication
Facility staff failed to observe changes caused by client's adverse reaction to medication
Facility staff is withholding client's P&I money
Facility staff are not assisting client with access to haircuts and other personal errands
Facility staff are not ensuring clients have an opportunity to participate in activities

INVESTIGATION FINDINGS:

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LIcensing Program Analyst (LPA) Teresa Camara conducted an initial complaint visit to the facility. LPA was joined by Tri-Counties Regional Center (TCRC) Quality Assurance Specialist (QAS) Liz Aced-Arnett. LPA and QAS initially met with lead staff 1 (S1) as the administrator was out of town. Administrator DiDi Daniel arrived at the facility at 1:30 p.m. LPA explained the reason for the visit.

At 11:18 a.m. LPA conducted a brief facility tour. At 11:20 a.m. LPA conducted an interview with S1. At 11:37 a.m., 1:19 p.m. and 1:22 p.m. LPA interviewed clients. At 11:50 a.m. LPA conducted a medication and records review. Interviews conducted with residents and staff revealed residents are taken on errands when they ask, as long as they have the funds to pay for what they are planning to purchase. There was no record or staff recollection of client 1 (C1) having an adverse reaction to medication. There was no evidence C1's P&I money was being withheld. Clients confirmed they participate in activities. C1 chooses not to participate in a day program; the rest of the clients go to day programs. Based on the interviews and records, no deficiencies were observed. Exit interview conducted and report issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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