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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191221067
Report Date: 05/09/2024
Date Signed: 05/09/2024 03:02:00 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
06/13/2023 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20230613161942
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:
05/09/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Felix CamposTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility staff is using illegal drugs
INVESTIGATION FINDINGS:
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On 5/09/2024 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.

LPA Spaeth and the Administrator toured the facility at 10:15 am until 10:30 am.

The investigation consisted of the following: On 06/20/2023 Licensing Program Analyst (LPA) Melissa Spaeth and Licensing Program Manager (LPM) Troy Agard initiated a complaint investigation. LPA Spaeth requested and received the staff roster and the resident roster. LPA Spaeth and LPM Agard conducted a collateral visit at an adult day program at 11:00 am until 11:45 am.

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

DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
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-20230613161942
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: 05/09/2024
NARRATIVE
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The investigation revealed the following: Regarding the allegation, Facility staff are using illegal drugs.. it’s being alleged that two staff members (S1 and S2) are using illegal drugs. Six clients out of the six clients stated they have not witnessed S1 and S2 using illegal drugs. Six clients out of the six clients stated other clients living in the facility have never stated they observed S1 and S2 using illegal drugs.

LPA Spaeth also interviewed the Administrator who stated has never witnessed S1 and S2 using illegal drugs and stated the clients have never stated they witnessed S1 and S2 using illegal drugs.

LPA Spaeth attempted to interview S1 and S2; however they were not available.

Based on the client and Administrator interviews, the allegation is unsubstantiated.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2