<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197602540
Report Date: 10/21/2025
Date Signed: 10/21/2025 05:01:38 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.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
10/15/2025 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20251015081304
FACILITY NAME:BELLAMAR LANCASTERFACILITY NUMBER:
197602540
ADMINISTRATOR:ANALILIA ZARZGOZAFACILITY TYPE:
740
ADDRESS:43454 30TH STREET WESTTELEPHONE:
(661) 949-2177
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:68CENSUS: 44DATE:
10/21/2025
UNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Kortnie Spitznogle - Executive DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure the facility is clean and sanitary.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/21/2025 Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced initial complaint visit for the above mentioned allegation. LPA met with Kortnie Spitznogle the Executive Director and explained the reason for the visit.

At 10:45 a.m., LPA interviewed Jesse Wong the Resident Care Director. LPA requested and obtained records pertinent to the investigation not limited to client roster, resident roster, housekeeper job description, housekeeper schedule and facility's admission agreement.

At 11:15 a.m., LPA Rios initiated a physical plant tour of the facility to ensure the health and safety of the residents in care. During the tour, LPA made observations of seven (7) resident bedrooms and their bathrooms, the common areas such as the dining area, activity room, and the memory care unit. From approximetly 11:30 a.m., to 2:00 p.m while conducting the tour LPA interviewed six (06) residents of which one did not respond to LPA's questions. (Continue to LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
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 4
Control Number 31-AS-20251015081304
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: BELLAMAR LANCASTER
FACILITY NUMBER: 197602540
VISIT DATE: 10/21/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 LPA also interviewed five (05) staff members not including the Executive Director, Resident Care Director and a Hospice nurse identified as providing care to a resident in question.

Allegation: Staff do not ensure the facility is clean and sanitary. Regarding the allegation, it was reported that staff are not cleaning the common areas, resident apartment rooms, and bathrooms. During the investigation, LPA observed five (5) out of seven (7) resident apartments and their corresponding bathrooms. These areas were found to be in varying states of uncleanliness. Specifically, LPA noted visible residue on shower floors, toilet bowls, and spills on the flooring surfaces. According to the Executive Director the housekeeping schedule is once a week. LPA's review of the staff roster revealed that only one individual is assigned to the Housekeeper position.

Review of the job duties revealed not verbatim, the responsibilities of this role include cleaning bathroom fixtures in resident apartments—such as bathtubs, toilets, showers, and sinks—as well as sweeping, wet mopping, and vacuuming within resident rooms. LPA's Interview with five (05) out six (6) residents that responding to LPA's questions revealed they are unsatisfied with the Housekeeper's ability to perform their job duties. Review of the admission agreement states the facility will provide residents with regularly scheduled housekeeping services. LPA's review of the admission agreement did not reveal a once a week schedule for resident room and corresponding bathroom cleaning. LPAs interview with the housekeeper revealed they were off last week which could account for the state of certain rooms today. Interviews with two (02) staff revealed residents and their family members have complained about room cleanliness of which the staff have also observed to be lacking. Based on LPAs observations and interviews with residents, this allegation is deemed Substantiated at this time.

Citation cited(refer to LIC9099-D). Exit interview conducted. Appeal Rights provided. Copy of report provided.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20251015081304
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: BELLAMAR LANCASTER
FACILITY NUMBER: 197602540
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/03/2025
Section Cited
CCR
87303(a)
1
2
3
4
5
6
7
87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met by:
1
2
3
4
5
6
7
The Executive Director (ED) immediately requested the housekeeper to clean room 110. The ED will ask for a volunteer to get one more staff member cross trained for housekeeping until a second housekeeper can be hired.
8
9
10
11
12
13
14
Based on LPA’s observations five (5) out of (7) resident apartments and their bathrooms were not kept clean or in sanitary conditions which poses a potential Health, Safety, or Personal Rights risk to persons in care.
8
9
10
11
12
13
14
Current housekeeper will redo ISO housekeeping training and provide a copy to LPA once completed.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4