197607701-1-5-2026-31-AS-NMAN-DQHSBL-20260120124408

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607701
Report Date: 01/05/2026
Date Signed: 01/05/2026 09:58:49 AM

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
09/15/2025 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20250915204640

FACILITY NAME:	EASTER SEALS SOUTHERN CALIFORNIA DEBRA HOME		FACILITY NUMBER:	197607701
ADMINISTRATOR:	BARBARA PACHECO		FACILITY TYPE:	735
ADDRESS:	10101 DEBRA AVE		TELEPHONE:	(818) 894-6938
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	4	CENSUS: 4	DATE:	01/05/2026
		UNANNOUNCED	TIME BEGAN:	09:22 AM
MET WITH:	Juana Gomez- designee		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff did not follow resident's care plan for repositioning.
Staff did not provide incontinence care to resident as needed.
Due to improper care client developed pressure injuries.

INVESTIGATION FINDINGS:

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At approximately 9:22AM, Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent complaint visit in response to the above-mentioned allegations. LPA met with Staff #1 (S1), who granted access to the facility.

To investigate the allegations on 9.17.2025, at 10:00am, LPA requested clients and staff roster. LPA conducted a physical plant tour at around 10:35 AM. At 10:48 AM – 12:04 PM, LPA interviewed the Administrator, four (4) staff, and attempted to interview four (4) out of four (4) clients who were present during the visit. Three (3) out of four (4) clients are non-verbal, and LPA was unable to communicate.

In addition, at 12:05 PM, LPA requested and reviewed copies of pertinent information, which included, but were not limited to Physician’s report, Clients medical records, appraisal, need and service plan, IPP, and other documents relevant to the investigation.
Continue to LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250915204640

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: EASTER SEALS SOUTHERN CALIFORNIA DEBRA HOME	FACILITY NUMBER: 197607701
	VISIT DATE: 01/05/2026

NARRATIVE

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-- Staff did not follow resident's care plan for repositioning
-- Due to improper care client developed pressure injuries.

In regard to the above allegations, it was reported that the facility staff was not following client #1 (C1)’s care plan to turning C1 as frequently as they should have, therefore causing a pressure injury specifically on the heels and buttocks. The stages of the pressure injuries were not disclosed. Interviews with four (4) of four (4) staff reveal that C1 does not have any pressure injuries greater than a stage II. Staff also reveal that they follow C1’s need and service plan and are reposition C1 every two (2) hours. Review of C1’s records reveal that C1 is receiving home health care. Home health records indicating Stage II pressure injuries at the coccyx area and heel being treated by home health, podiatrist, and facility staff. No indication on file that C1 has anything greater than a stage II injury. Per records, present pressure injuries were healing. A review of C1’s facility records, including need and service plan, verified that staff has been changing R1's diaper and repositioning C1 every two hours. Based on the information obtained, interview, and record review, there was insufficient evidence to verify that C1 developed a pressure injury due to improper care and staff not following C1 care plan to reposition. Therefore, the allegation is deemed Unsubstantiated at this time.

-- Staff did not provide incontinence care to resident as needed

It was alleged that staff are double diapering C1. During the physical plant tour, LPA did not experience any malodor and observed that all residents were clean and well groomed. During interviews with the administrator, staff S4 and Staff S5 stated that they change C1 diaper every two (2) hours when re-position them and more if needed. S4 and S5 also stated that they do not put on more than one diaper at a time. At 12:42 pm, LPA observed staff repositioning C1 and did not observe C1 having a double diaper.

Based on interviews and observation, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No immediate health and safety hazard is noted during this visit.

An exit interview was conducted, and a copy of the report was issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026

LIC9099 (FAS) - (06/04)

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