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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191221067
Report Date: 06/06/2025
Date Signed: 09/18/2025 02:07:05 PM

Substantiated


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
06/05/2025 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20250605130645
FACILITY NAME:CAMPOS CARE HOMEFACILITY NUMBER:
191221067
ADMINISTRATOR:FELIX I. CAMPOS JR.FACILITY TYPE:
735
ADDRESS:226 E. AVENUE Q-3TELEPHONE:
(661) 274-9509
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:6CENSUS: 4DATE:
06/06/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Felix CamposTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility has bed bugs.
INVESTIGATION FINDINGS:
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This is an amended copy of the report previously issued on 06/06/2025 & supersedes reports previously issued. The findings for this complaint remain the same.

On 6/06/2025 Licensing Program Analyst (LPA) Melissa Spaeth and Licensing Program Manager Troy Agard initiated a complaint investigation for the allegation(s) listed above and met with the Administrator Felix Campos. LPA Spaeth explained the purpose of the visit is to tour the facility, interview clients, and present the findings.

Regarding the allegation, Facility has bed bugs: It is being alleged clients living in the facility has bed bugs in their rooms and have bed bug bites. LPA and LPM toured the facility at 9:30 am until 10:00 am. LPA Spaeth interviewed four (4) out of five clients at 10:15 until 10:40 am. Three clients (C1, C2, C3) stated they had bed bugs in their room and bed bug bites. C4 stated they did not have bed bugs and no bites. C4 was unavailable for an interview.

Based upon client interviews, the complaint is substantiated. Exit interview conducted, appeal rights discussed and a copy of the report was given.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025
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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Control Number 31-AS-20250605130645
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/10/2025
Section Cited
CCR
80087(a)
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This is an amended copy of the report previously issued on 06/06/2025 & supersedes reports previously issued. The findings for this complaint remain the same.
80087(a) The facility shall be...
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The Licensee will have the facility sprayed by a professional exterminator and provide a copy of the receipt to LPA Spaeth via email by 6/10/2025.
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safe & in good repair... This requirement is not met as evidenced by: The Licensee failed to ensure the bed bugs were eliminated from the facility which could pose a potential health & safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025
LIC9099 (FAS) - (06/04)
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