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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191221933
Report Date: 07/07/2025
Date Signed: 08/21/2025 11:30:20 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
07/03/2025 and conducted by Evaluator Huma Rahimi
COMPLAINT CONTROL NUMBER: 31-AS-20250703124552
FACILITY NAME:MATEO'S GUEST HOMEFACILITY NUMBER:
191221933
ADMINISTRATOR:MATEO, CAROLINA & ROGELIOFACILITY TYPE:
735
ADDRESS:6861 TAMPA AVE.TELEPHONE:
(818) 776-8716
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:4CENSUS: 4DATE:
07/07/2025
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Carolina Mateo, AdministratorTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Licensee speaks inappropriately to clients in care.
Licensee does not treat clients with dignity and respect.
Licensee hit client in care.
INVESTIGATION FINDINGS:
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This is an Amendment to the original report issued 07-07-2025, additional information was added to clarify the investigation.
At 10:05 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced complaint visit to investigate the above stated allegations. LPA was allowed entry by Administrator/Licensee Carolina Mateo. LPA explained the reason for the visit. An entrance interview was conducted. The Administrator had to leave and designated the Staff, Elaine Ponferrada, to sign today's report.

During course of the investigation, interviews and record review were made. At 10:10 AM, LPA requested client and staff roster. At 10:15 AM, LPA requested copies of pertinent information which include, but not limited to Staff training, Physician Report, Admission Agreement, Appraisal Needs and Services Plan and ect., relevant to the course of investigation. At approximately 10:20 AM, LPA conducted a physical plant tour. Between 11:00 AM – 1:30 PM, LPA conducted an interview with the Administrator, the Licensee, and two (2) clients who were available. At 4:45 PM, LPA conducted an additional interview with Client #3 (C3).
Continue on LIC 9099C


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
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 5
Control Number 31-AS-20250703124552
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: MATEO'S GUEST HOME
FACILITY NUMBER: 191221933
VISIT DATE: 07/07/2025
NARRATIVE
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Licensee speaks inappropriately to clients in care.

The complainant concern is that unfriendly words were exchanged between Client #1 (C1) and the Licensee on or about 06/12/2025. To investigate this allegation LPA conducted an interview with the Administrator and was informed that an incident occurred on 06/12/2025 at around 7:00 PM due to a lot of noise of the music and the blender. The Licensee demanded everyone to keep quiet and go to their rooms which escalated to a verbal altercation between the Licensee and C1. Furthermore, both the Administrator and Licensee denied the allegation and stated that they never spoke to any clients or C1 inappropriately. However, interview with three (3) out of four (4) clients who were able to communicate confirmed that the Licensee did speak inappropriately to C1 and as well to the Administrator in their presences on 06/12/2025. Therefore, based on interviews conducted, there is sufficient information to prove that the allegation has happened; and therefore, the allegation is deemed Substantiated.

Licensee does not treat clients with dignity and respect.

The complainant concern is that the Licensee did not treat clients with dignity and respect during an incident of a verbal altercation between the Licensee and C1 which occurred on 06/12/2025. The Licensee stated that "I am the man of the home, you do not talk to me that way." To investigate this allegation LPA conducted an interview with the Administrator and was informed that due to a lot of noise the Licensee disconnected the music and demanded everyone including Administrator to go to their rooms and keep quiet. Additionally, LPA conducted a telephonic interview with the Licensee who also confirmed that Licensee was at the facility on 06/12/2025. Furthermore, the Licensee admitted directing clients into their rooms; however, he denied being disrespectful towards them. The Licensee also added that all clients must follow his commends as it is how supposed to be. Although, Licensee never admitted being verbally disrespectful, interview with three (3) out of four (4) clients witnessed and confirmed that there was a verbal altercation where the Licensee was verbally disrespectful to C1. Therefore, based on the interview’s information collected, there is enough evidence to support the allegation and is deemed Substantiated.

Continue on LIC 9099C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20250703124552
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: MATEO'S GUEST HOME
FACILITY NUMBER: 191221933
VISIT DATE: 07/07/2025
NARRATIVE
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Licensee hit client in care.
The complainant concern is that the Licensee poked C2's ear with his finger and as a result C2 cried and was in pain. To investigate this allegation LPA conducted an interview with the Administrator and was informed that during the verbal altercation between C1 and the Licensee on 06/12/2025, the licensee directed clients with hand gesture to go to their rooms which accidentally caused Licensee poking C2’s ear. Interview with both the Administrator and Licensee denied of poking/hitting C2 intentionally. LPA conducted interview with three (3) out of four (4) clients who were able to communicate, and all clients interviewed confirmed that the Licensee poked C2’s ear. Although there was no evidence of physical bruising/skin scratch, C2 stated that she/he had pain and discomfort for a day. Based on interviews there is enough information to support the allegation; therefore, this allegation is deemed Substantiated.


Citations issued and appeal rights explained and given.

Exit interview conducted and copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20250703124552
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: MATEO'S GUEST HOME
FACILITY NUMBER: 191221933
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/14/2025
Section Cited
CCR
80072(a)(1)
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80072 Personal Rights (a)Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons. This was not met as evidence by:
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Administrator agrees by phone to have all facility staff take vendorized training on Personal Rights and will submit proof of training to LPA by POC due date.
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Based on interviews the Licensee failed to ensure that clients personal rights were protected, in which the Licensee engaged in speaking to clients inappropriately and treated clients disrespectfully. This poses a potential health and safety risk to residents 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: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20250703124552
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: MATEO'S GUEST HOME
FACILITY NUMBER: 191221933
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/09/2025
Section Cited
CCR
80072(a)(3)
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80072(a)...each client shall have personal rights which include, but are not limited to, the following:(3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation...
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Administrator removed the Licensee from the premises. The Administrator will conduct in service training reviewing this section of the regulation. The Administrator will provide attendance sheet of all staff that have attended the training by the POC due date.
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Based on the interviews the Licensee accidently poked C2 ear which caused pain and discomfort to C2 which posed an immediate health and safety risk or personal rights risk to persons 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: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5