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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603485
Report Date: 02/05/2025
Date Signed: 02/05/2025 01:44:33 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS 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
01/31/2025 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20250131114516
FACILITY NAME:POWELL HOUSE, INC.FACILITY NUMBER:
197603485
ADMINISTRATOR:AMALIA SANDIOVALFACILITY TYPE:
735
ADDRESS:1212 E. PASTEUR DR.TELEPHONE:
(661) 729-2175
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:4CENSUS: 4DATE:
02/05/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Amalia SandovalTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff do not provide client with adequate food service.
Staff retaliate against client when they speak up.
INVESTIGATION FINDINGS:
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On 02/05/2025 at 09:15 am Licensing Program Analyst (LPA) Lorena Casillas conducted an unannounced complaint visit to investigate the above stated allegations. LPA was met with Nancy Diggs from North Los Angeles Regional Center, at the facility. Administrator, Amalia Sandoval arrived shortly and granted access. LPA explained the reason for the visit. An entrance interview was conducted.

At 09:30 am LPA Casillas conducted a physical plant tour. During the investigation, interviews and record reviews were conducted from 10:00 am to 1:30 pm. LPA requested copies of client roster, LIC 500, Bond Certificate and Administrator Certificate. LPA requested copies of pertinent information relevant to the investigation including but not limited to appraisals, client medical records, behavior logs, menu and any information pertaining to clients in care.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
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 3
Control Number 31-AS-20250131114516
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: POWELL HOUSE, INC.
FACILITY NUMBER: 197603485
VISIT DATE: 02/05/2025
NARRATIVE
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Allegation #1: Staff do not provide client with adequate food service.

It is alleged that staff do not provide client with adequate food service. Regarding this allegation, it is reported that staff do not provide Client #1 (C1) with lunch for C1 to take to program. LPA interviewed Administrator who stated that C1 does not like to take lunch to program and even though lunches are made for C1, C1 prefers to leave lunches behind. According to Administrator, when C1 returns from program, C1 prefers to eat food from fast food places or snacks. Interview with Staff #1 (S1) revealed that S1, and other staff, will make lunch for C1 to take to program but most of the time C1 will not take lunch to program. Interview with C1 revealed that C1 admittedly leaves lunch behind because C1 prefers to eat when they get home or when program takes clients to restaurants. C1 also revealed that they do not like carrying a lunch to program and prefer not to eat what the facility provides by choice. C1 did reveal that all clients are asked what they prefer to eat and do contribute to putting the menu together, C1 just chooses not to always eat the meals provided. Interview with Client #2 (C2) and Client #3 (C3) via phone revealed that facility does provide all meals for them unless they go on outings, then they can purchase a meal if they prefer, however meals and snacks are never denied. C2 and C3 also stated that all clients are included in preparing the menu for the week and are encouraged to provide what foods they like and dislike. LPA reviewed facility’s current menu along with the following weeks menu and both weeks’ worth of food are in stock at the facility. Based on interviews, record review and observations this allegation is deemed unsubstantiated.

Continued on LIC9099-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250131114516
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: POWELL HOUSE, INC.
FACILITY NUMBER: 197603485
VISIT DATE: 02/05/2025
NARRATIVE
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Allegation #2: Staff retaliate against client when they speak up.

It is alleged that staff retaliate against client when they speak up. Regarding this allegation, it is reported that when C1 spoke to program staff regarding undisclosed concerns, that the facility staff in retaliation, did not provide C1 with lunch for program. LPA interviewed Administrator and it was revealed that this is not the case. Administrator states that C1 chooses not to take lunch to program and that they would never deprive any client of meals, nor have they ever retaliated against clients for speaking up. LPA interviewed S1 and S1 states that all clients are encouraged to share concerns with any of the staff members, S1 denied retaliating against any clients for any reason. Interview with C1 revealed that C1 says things but means other things, and that this is part of the way that C1’s brain works. C1 denied being retaliated against by staff or Administrator and admitted that not taking lunch is a choice that C1 made, further stating that what C1 said was misunderstood by program staff. LPA interviewed C2 and C3 who denied that staff or Administrator retaliate against them and stated that staff are very supportive towards all clients. LPA reviewed all client IPP’s and appraisals and it was discovered that C1 has “a history of habitual lying” as part of their behavior. Therefore, based on interviews, observations, and record review this allegation is deemed unsubstantiated.

No citations issued. Exit interview conducted. Copy of report provided to Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3