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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191221067
Report Date: 04/05/2024
Date Signed: 04/05/2024 04:12:20 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/02/2024 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20240402155343
FACILITY NAME:CAMPOS CARE HOMEFACILITY NUMBER:
191221067
ADMINISTRATOR:CECILIA T. CAMPOSFACILITY TYPE:
735
ADDRESS:226 E. AVENUE Q-3TELEPHONE:
(661) 274-9509
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:6CENSUS: 6DATE:
04/05/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Felix CamposTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Residents are left unattended without care or supervision from staff
Staff do not ensure that residents are adequately fed
Staff are prohibiting residents from visiting with family
INVESTIGATION FINDINGS:
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On 4/04/2024 Licensing Program Analyst (LPA) Melissa Spaeth conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA Spaeth was met by the Administrator Felix Campos. LPA explained the purpose of this visit was to deliver the findings for this complaint.

The investigation consisted of the following: On 4/03/2024 LPA Spaeth initiated a complaint investigation. LPA toured the physical plant at 11:00 am until 11:20 am. LPA reviewed resident records at 11:20 am until 11:40 am and requested the resident roster, and staff phone numbers. LPA Spaeth received the documentation on 4/03/2024. LPA requested a copy of the visitor’s log, however, there is not a visitor’s log. LPA Spaeth interviewed six (6) out of six (6) residents and one staff member out of the three staff members. Two staff members refused to be interviewed.

Cont. on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
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 2
Control Number 31-AS-20240402155343
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CAMPOS CARE HOME
FACILITY NUMBER: 191221067
VISIT DATE: 04/05/2024
NARRATIVE
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The investigation revealed the following: Regarding the allegation, Residents are left unattended without care or supervision from staff. It’s being alleged residents are left unattended and sometimes left over night with no one to help if there is an emergency. Five clients out of the six clients stated the night staff members do not leave the clients on their own. All five clients stated they see the night staff members every evening. C1 stated the night staff have left clients on their own. S2 confirmed six clients have never stated the night staff have left the residents unattended. The Administrator denied the allegation.

Regarding the allegation staff do not ensure the residents are adequately fed. It’s being alleged certain meals are prepared by staff members, some meals are prepared by residents, and unhealthy or pre-packaged food is provided. Five clients out of six clients confirmed breakfast is provided each morning. C1 states it is not provided. Five clients out of the six clients confirmed they are provided lunch and dinner. They also confirmed they do not prepare their own meals. C1 stated they did not receive lunch and they sometimes have to prepare their own meal. Five clients out of six clients also stated frozen dinners are only served once in a while. C1 stated frozen dinners are served all the time. S2 stated they always prepare cooked meals and never serve frozen meals. The Administrator denied the allegation.



Regarding the allegation, Staff are prohibiting residents from visiting with family. It was alleged clients are forced to attend the adult day program rather than being able to visit family. Five out of the six clients stated they are able to see family members. C1 stated they are not allowed to visit family members. S2 confirmed clients are able to visit family members. The Administrator denied the allegation.

Based on interviews of the clients and the staff member, the allegations are unsubstantiated.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
LIC9099 (FAS) - (06/04)
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