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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 567609849
Report Date: 08/18/2023
Date Signed: 08/20/2023 08:58:43 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
04/12/2023 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20230412125937
FACILITY NAME:PCS - FERNWOODFACILITY NUMBER:
567609849
ADMINISTRATOR:DANIEL, DADESIIFACILITY TYPE:
735
ADDRESS:515 FERNWOOD DRTELEPHONE:
(805) 307-1810
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY:4CENSUS: 4DATE:
08/18/2023
UNANNOUNCEDTIME BEGAN:
11:16 AM
MET WITH:Dadaesii "DiDi" DanielTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not offering clients appropriate activities.
Facility is not ensuring client has proper hygiene.
Facility is not providing adequate housekeeping services.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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 records review. Interviews conducted with clients and staff revealed clients are taken on errands when they ask, as long as they have the funds to pay for what they are planning to purchase. Clients confirmed they participate in activities, usually on the weekends, as they also go to day programs on weekdays. Facility, including client rooms and bedding, were observed to be clean. Clients were all well groomed and shower daily. 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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