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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609302
Report Date: 03/25/2026
Date Signed: 03/25/2026 03:13:02 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/17/2026 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20260317135552
FACILITY NAME:KELLY HOUSE INCFACILITY NUMBER:
197609302
ADMINISTRATOR:TEKOA HUEYFACILITY TYPE:
735
ADDRESS:1859 UPPER COURTTELEPHONE:
(323) 635-8150
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:6CENSUS: 4DATE:
03/25/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tekoa Huey, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not safeguard resident's funds
Staff did not maintain accurate facility records
Staff handled clients in a rough manner
INVESTIGATION FINDINGS:
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At 10:00am, Licensing Program Analyst (LPA), Angela Panushkina conducted an unannounced visit in response to the above-mentioned allegations. LPA met with the House Manager and explained the reason for the visit.

LPA requested client and staff rosters. At 10:20am, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, Individual Program Plan (IPP), Staff Training, Personal and Incidental (P&I) Records/ Record of Client's Safeguarded Cash Resources, relevant to the investigation. At approximately 10:30am, LPA conducted a physical plant tour. Between 10:45am – 01:00pm, LPA conducted an interview with the Administrator, House Manager, three (3) staff, and four (4) out of four (4) clients.

Continue on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026
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-20260317135552
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: KELLY HOUSE INC
FACILITY NUMBER: 197609302
VISIT DATE: 03/25/2026
NARRATIVE
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Allegation: Staff did not safeguard resident's funds

LPA conducted an interview with the Administrator, who denied the above allegation and stated that client funds are handled appropriately. The Administrator informed LPA that the staff are expected to safeguard clients’ personal property and funds in accordance with facility policy and applicable regulations. Clients’ daily distribution of P&I is also based on their individual IPP’s and is being handled only by the Administrator or the House Manager. Additionally, the House Manager and the three (3) staff interviewed also denied the above allegation and confirmed the statement provided by the Administrator. LPA was informed that most of the P&I money is being spent on fast food and video games. Staff informed LPA that they do not use clients’ funds for personal purposes, do not purchase items under clients’ names for themselves, and do not retain or discard receipts in an inappropriate manner. Staff reported that client funds and purchases are handled in accordance with facility procedures. Four (4) clients interviewed expressed no concern regarding this allegation. During today’s interview, clients did not report misuse of their money, missing money or unauthorized purchases made by staff. Clients indicated they feel comfortable residing at the facility and the staff treat them very well. Lastly, LPA observed clients to be comfortable, happy, and appropriately cared for. LPA also observed staff interacting with clients in a friendly, caring and respectful manner. Therefore, based on interviews, record reviews and LPA observation, this allegation is deemed Unsubstantiated, at this time.

Allegation: Staff did not maintain accurate facility records

Interview with the Administrator revealed that the facility records are maintained as required and denied that documentation was ever fabricated or inaccurately completed. The Administrator also reported that the staff are instructed to complete documentation accurately and timely in accordance with facility procedures and regulatory requirements. House Manager and three (3) staff interviewed denied the above allegation and informed LPA that facility documentation is completed based on services provided and client needs and also denied falsifying records or intentionally documenting inaccurate information. Staff reported that records are maintained in the ordinary course of business and to the best of their knowledge are accurate. LPA conducted review of four (4) out of four (4) clients files, including P&I records (money, receipts, etc.) and observed that all records are accurate and up to date. Therefore, based on interviews, record reviews and LPA observation, this allegation is deemed Unsubstantiated, at this time.

Continue on LIC9099-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20260317135552
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: KELLY HOUSE INC
FACILITY NUMBER: 197609302
VISIT DATE: 03/25/2026
NARRATIVE
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Allegation: Staff handled clients in a rough manner

Interview with the Administrator revealed that the staff are trained to provide care and supervision in a respectful manner and denied any knowledge of staff handling clients roughly or engaging in abusive conduct. The House Manager and three (3) staff members interviewed also denied the above allegation and informed LPA that they treat clients with dignity and respect. Staff reported that care is provided according to each client’s needs and in a supportive and respectful manner. Four (4) out of four (4) clients interviewed expressed no concern regarding the above allegation and informed LPA that they feel very safe at this facility and that staff are caring and helpful. Lastly, during today’s visit, LPA observed all staff interacting with clients in a friendly, calm and caring manner. Therefore, based on interviews and LPA observation, this allegation is deemed Unsubstantiated, at this time.

No deficiency issued during today's visit.

Exit interview conducted. Appeal rights explained and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3