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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191221067
Report Date: 06/11/2025
Date Signed: 09/18/2025 02:16:19 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
04/23/2025 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20250423102042
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: 5DATE:
06/11/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Felix CamposTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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9
Staff member caused injury to resident in care
INVESTIGATION FINDINGS:
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This is an amended copy of the report previously issued on 06/11/2025. This report supersedes reports previously issued. The findings for this complaint remain the same.

Licensing Program Analyst (LPA) Melissa Spaeth and Licensing Program Manager (LPM) Troy Agard conducted an unannounced subsequent complaint investigation for the allegation(s) listed above. LPA and LPM was met by the Administrator, Felix Campos. LPA Spaeth stated the purpose of the visit was to present the complaint findings.

On 4/23/2025 a complaint was received by the Woodland Hills Adult & Senior Care Regional Office. The complaint was referred to Community Care Licensing Division’s Investigation Branch as an assignment to investigate the complaint on 4/23/2025.
The investigation consisted of the following: On 4/23/2025, LPA Spaeth and LPA Evelin Rios conducted a 10-day visit and toured the facility.

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

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
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 4
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
04/23/2025 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20250423102042

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: 5DATE:
06/11/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Felix CamposTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff member sexually assaulted resident in care.
Staff member physically abused resident in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This is an amended copy of the report previously issued on 06/11/2025. This report supersedes reports previously issued. The findings for this complaint remain the same.

Licensing Program Analyst (LPA) Melissa Spaeth and Licensing Program Manager (LPM) Troy Agard conducted an unannounced subsequent complaint investigation for the allegation(s) listed above. LPA and LPM were met by the Administrator, Felix Campos. LPA Spaeth stated the purpose of the visit was to present the complaint findings. On 4/23/2025 a complaint was received by the Woodland Hills Adult & Senior Care Regional Office. The complaint was referred to Community Care Licensing Division’s Investigation Branch as an assignment to investigate the complaint on 4/23/2025. The investigation consisted of the following: On 4/23/2025, LPA Spaeth and LPA Evelin Rios conducted a 10-day visit and toured the facility. Regarding the allegation: Staff member sexually assaulted resident in care: It’s being alleged that a client was sexually assaulted by a staff member. C1 was interviewed by Investigator Douglas and did not confirm they were sexually assaulted. C2-C4 confirmed C1 did not state they were sexually assaulted by a staff member. Based upon client and staff interviews, the allegation is unsubstantiated.
Regarding the allegation: Staff member physically abused resident in care: It’s being alleged that a client was physically abused by a staff member. C1 stated they were physically assaulted by a staff member. C2-C4 confirmed they heard a commotion but did not witness the alleged incident. C3 confirmed they went outside and saw C1, S1, and S2 on the ground. C2-C4 confirmed C1 did not state they were physically abused by a staff member. Based upon client and staff interviews, the allegation is unsubstantiated. Exit interview conducted & a copy of the report was given.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 31-AS-20250423102042
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: 06/11/2025
NARRATIVE
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This is an amended copy of the report previously issued on 06/11/2025. This report supersedes reports previously issued. The findings for this complaint remain the same.

An assignment was conducted by IB Investigator, Dennis Douglas. During the course of the investigation, Investigator Douglas interviewed three (3) out of five (5) clients and two (2) staff members (S1-S2) on 4/25/2025. LPA Spaeth also interviewed C4 on 6/09/2025 at 2:00 pm. C5-C6 were unavailable for an interview.

Regarding the allegation: Staff member caused injury to resident in care: It’s being alleged a client was injured by a staff member. C1 confirmed they had bruises and wounds due to staff assaulting them. C2-C4 stated they observed C1’s bruises and wounds but C1 did not state what happened. S1 confirmed they had a physical altercation with C1. LPA Spaeth received snapshots of C1’s bruises and wounds. Based upon client and staff interviews and the photos of C1’s injuries, the allegation is substantiated.

Exit interview conducted, appeal rights discussed, and a copy of the report was given.

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

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20250423102042
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: 06/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/19/2025
Section Cited
CCR
80072(a)(3)
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7
This is an amended copy of the report previously issued on 06/11/2025. This report supersedes reports previously issued. The findings for this complaint remain the same.

80072 Personal Rights (a) …each client shall have personal rights which include…(3) To be free from ...infliction of pain...This requirement is not met as evidenced by:
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The Licensee will submit a written letter stating they have reviewed 80072 Personal Rights and that going forward will adhere to the regulation.
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The Licensee failed to ensure clients are accorded a safe environment free from infliction of pain or intimidation. This poses a potential health and 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: 06/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4