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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850090
Report Date: 07/10/2025
Date Signed: 07/10/2025 03:34:37 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/08/2025 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20250708085438
FACILITY NAME:SUNSHINE RESIDENTIAL HOME BALBOAFACILITY NUMBER:
195850090
ADMINISTRATOR:JOSE, OYINLOYE AUSTINEFACILITY TYPE:
735
ADDRESS:7431 JELLICO AVENUETELEPHONE:
(818) 274-1809
CITY:LAKE BALBOASTATE: CAZIP CODE:
91406
CAPACITY:4CENSUS: 3DATE:
07/10/2025
UNANNOUNCEDTIME BEGAN:
12:07 PM
MET WITH:Toluwalope JoseTIME COMPLETED:
03:24 PM
ALLEGATION(S):
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Staff hit resident with an object.
Staff did not prevent resident from engaging in inappropriate behaviors.
Staff inappropriately put a pillow over resident’s head.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sandra Urena conducted an initial unannounced visit to investigate the allegations listed above. The LPA was greeted by staff, and staff contacted the Administrator via telephone to inform them of the visit. The Administrator stade they could not make it to the facility, consequently the LPA inform the Administrator about the reason for the visit and read the report to them over the phone.

LPA Urena, along with the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations.

LPA Urena requested records pertinent to the allegation and interviewed residents, staff and Administrator from approximately 01:25 p.m. to 2:45 p.m.

Continues on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
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
Control Number 29-AS-20250708085438
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNSHINE RESIDENTIAL HOME BALBOA
FACILITY NUMBER: 195850090
VISIT DATE: 07/10/2025
NARRATIVE
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Staff hit resident with an object.
It is alleged that a staff (S1) hit a resident (R1) on the legs with a broom, however no injuries were sustained. To investigate the allegation, LPA Urena conducted record reviews and interviews. On 07/09/2025, LPA Urena interviewed staff from the North County Los Angeles Regional Center (NCLARC) from approximately 4:09 p.m. to 4:56 p.m. The interview revealed that NCLARC staff received information from the hospital that no injuries or bruises were observed during the admission medical examination of R1 on 06/26/2025. The facility is vendored through NCLARC. NCLARC conducts independent investigations, and the investigation conducted on 06/27/2025, by the Quality Assurance (QA) staff revealed that staff denied any inappropriate behavior towards R1. Furthermore, interviews conducted by the QA revealed that two residents were present during the time of the incident, the residents reported that they are happy living at the facility and have positive relationships with staff, and did not observe any staff hit R1. The LPA interviewed the Administrator, and the interview revealed that R1 has been staying at the facility on a 21-day respite admission, and R1 has been in and out of the hospital due to R1 calling 911 for various reasons, but specifically for threats of self-harm. The LPA interviewed staff, and staff denied abusing R1 physically or emotionally.
LPA Urena was unable to interview R1.

Although the allegation may have happened or is valid, based on the interviews and observation, there is not sufficient evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation that the staff hit R1 with a broom causing injury and or bruising is deemed Unsubstantiated at this time.


Continues on LIC 9099C...
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20250708085438
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNSHINE RESIDENTIAL HOME BALBOA
FACILITY NUMBER: 195850090
VISIT DATE: 07/10/2025
NARRATIVE
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Staff did not prevent resident from engaging in inappropriate behaviors.
It is alleged that R1 reported that they engaged in inappropriate behavior based on the incident in which staff did not prevent R1 from running outside and into the street. Per R1, the designated one-to-one staff (unknow name) for R1 was not present to supervise R1. However, R1 stated later, that R1 was eventually guided back into the facility by their assigned one-on-one and by another resident. The facility is vendored through the North County Los Angeles Regional Center (NCLARC). NCLARC conducts independent investigations, and the investigation conducted by the Quality Assurance staff on 06/27/2025 revealed that the staff present on the day of the incident denied allowing R1 to engage in inappropriate behavior. The staff interviews revealed that R1 displayed inappropriate actions towards a staff (S2), and when R1 was asked to stop, R1 ran out of the front door. Two staff followed R1 to the sidewalk, where R1 proceeded to try to flag down cars to stop. Furthermore, on 07/09/2025, LPA Urena interviewed staff from NCLARC from approximately 4:09 p.m. to 4:56 p.m. The interview revealed that NCLARC has not given authorization or provided additional funding to secure and assign a one-to-one staff for R1 at the facility.
The LPA interviewed the Administrator, and the interview revealed that the facility administrators assigned a one-to-one to R1, however the NCLARC has not created an IPP for R1, nor did they request or authorized a one-to-one staff for R1. Staff have worked with R1 and have made every effort to keep R1 safe.
The LPA interviewed staff, and the interviews revealed that R1 would take every opportunity available to leave the facility unaccompanied by staff. LPA Urena was unable to interview R1.

Based on the information obtained through interviews, there is not sufficient evidence to support the allegation that staff did not prevent R1 from running into the street. Therefore, the allegation is deemed Unsubstantiated at this time.

Continues on LIC 9099C...
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20250708085438
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNSHINE RESIDENTIAL HOME BALBOA
FACILITY NUMBER: 195850090
VISIT DATE: 07/10/2025
NARRATIVE
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Staff inappropriately put a pillow over resident’s head.
It is alleged that R1 stated that a staff guided R1 to R1’s room so that R1 could lay down to rest, and this is when it is alleged that staff, then put a pillow over R1’s head. NCLARC conducts independent investigations, and the investigation conducted by the NCLARC QA staff on 06/27/2025 revealed that staff denied any incidents of hitting, pushing, screaming at, or covering R1’s face with a pillow, or any similar behavior toward R1 or other residents. Residents’ interviews revealed that they have a positive relationship with staff.
On 07/09/2025, LPA Urena interviewed the RP, and when the LPA asked if R1 had provided additional details of the incident, such as how long was the pillowcase on R1’s head, or how it was removed, etc. the RP stated that R1 did not provide additional details of the incident, just that the pillowcase was placed over their head. Furthermore, the RP stated that R1 has made claims several times to staff that they hear voices which tell R1 to harm themselves. In at least one occasion staff have prevented R1 from harming themselves with extension cords and pens. LPA Urena conducted a record review of medical records dated 06/10/2025, which revealed that R1 was seen due to a mental breakdown where R1 was observed to be experiencing paranoid activity; R1 expressed that they hear voices, and the voices make people around R1 do evil things to R1. The interview with the Administrator revealed that they had knowledge that R1 was evaluated with paranoid tendencies, hearing voices and alleging that people are trying to hurt them.
The LPA interviewed staff, and the staff denied any inappropriate actions towards R1 or putting a pillow over R1’s head. LPA Urena was unable to interview R1.

Although the allegation may have happened or is valid, based on the interviews and record review there is not sufficient evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation that the staff put a pillow over the resident’s head, is deemed Unsubstantiated at this time.

Administrators authorized facility representative to sign report in their absence.

No citations were issued. Exit interview was conducted. A copy of the report was issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
LIC9099 (FAS) - (06/04)
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