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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850520
Report Date: 08/21/2025
Date Signed: 08/21/2025 04:31:33 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
08/11/2025 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20250811130435
FACILITY NAME:FINE GOLD MANORFACILITY NUMBER:
195850520
ADMINISTRATOR:CRISTINA GOMEZFACILITY TYPE:
740
ADDRESS:10537 MAGNOLIA BLVD.TELEPHONE:
(818) 761-5777
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91601
CAPACITY:100CENSUS: 60DATE:
08/21/2025
UNANNOUNCEDTIME BEGAN:
03:55 PM
MET WITH:Christina GomezTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Due to lack of supervision, resident physically assaulted another resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Trevor Byrne conducted a follow-up complaint visit for the above allegation. LPA arrived to the facility at 03:55 PM. LPA met with the facility staff who contacted the Administrator Christina Gomez. The Administrator arrived to the facility at 04:20 PM. Entrance interview conducted and the reason for the visit was explained.

During today’s visit, the LPA delivered findings for the above allegation.

Continued on LIC 9099C.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
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 2
Control Number 29-AS-20250811130435
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: FINE GOLD MANOR
FACILITY NUMBER: 195850520
VISIT DATE: 08/21/2025
NARRATIVE
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The allegation of “Due to lack of supervision, resident physically assaulted another resident” alleges that due to a lack of supervision by facility staff, Resident #1 (R1) and Resident #2 (R2) got into an altercation where R2 was physically assaulted. LPA interviewed the Administrator who described the altercation that took place on 08/07/2025 at approximately 05:00 PM as happening “out of the blue.” The Administrator stated that the altercation occurred in and around Resident #3’s (R3) room. The Administrator stated that facility staff were alerted to the altercation and responded to the incident but by the time they arrived the incident had concluded. The Administrator stated that paramedics and police were contacted but no medical transport was conducted, and no charges were pressed. The Administrator stated that video of the incident was recorded by the facility’s hallway cameras, but no audio of the incident was available. The Administrator showed LPA a recording of the incident. The recording showed R1 approaching R3’s room where R2 and R3 were meeting. R1 briefly entered the room and appeared to leave before returning shortly thereafter. R1 entered R3’s room and after a brief moment R1 backed out with R2 appearing to fall out of R3’s doorway onto the floor. R2 then grabbed onto R1’s leg and began kicking R1 in the stomach repeatedly from the floor. R1 broke free from R2’s grip and began backing away while R2 got up off of the floor and retreated back into R3’s room. LPA observed the entire altercation to last approximately thirty (30) seconds. LPA interviewed R1, R2, and R3. All residents interviewed stated that facility staff responded to the incident and authorities were notified. The residents interviewed all stated that the three (3) of them were very close friends prior to the incident and often spent time hanging out together. All residents denied an altercation like this occurring previously. R1 stated that they have been offered medical attention by the facility on multiple occasions, but they have denied treatment each time it is offered. R2 initially denied treatment at the time of the altercation but has had a follow-up with their primary care physician since the incident. Interviews with Staff #1 (S1) revealed that they and staff #2 (S2) responded to the altercation as soon as they were alerted but by the time they arrived on scene the altercation had concluded. S1 and S2 ensured emergency services were contacted, notified the Administrator of the event, and stayed with residents to keep them separated and prevent further escalation. LPA reviewed the employee schedule for the date of 08/07/2025. LPA observed a total of five (5) staff members to be present at the facility at the time the altercation took place. The interview with the Administrator revealed that the facility is taking precautions to ensure another altercation between the residents does not happen. The precautions taken include staff checks on R1 approximately every two (2) hours and moving R2, with their permission, to another room on the opposite side of the facility. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Due to lack of supervision, resident physically assaulted another resident.” Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted. The report was reviewed and a copy was provided.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
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)
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