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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609302
Report Date: 06/13/2025
Date Signed: 09/18/2025 01:55:55 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.ASC, 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
04/18/2025 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20250418113825
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:
06/13/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Rasheed Ade OrenowoTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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9
Client sustained multiple unexplained bruises
Staff handled a client roughly
INVESTIGATION FINDINGS:
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13
This is an amended copy of the report previously issued on 3/14/2025. This report supersedes reports previously issued. The findings for this complaint remain the same.

On 6/04/2025, Licensing Program Analyst (LPA) Melissa Spaeth conducted a subsequent visit for the allegation(s) listed above. LPA Spaeth explained the purpose of the visit was to present the findings.

The investigation consisted of the following: On 5/07/2025, LPA Spaeth conducted an unannounced complaint investigation. LPA received copies of the clients’ documentation, and a copy of the staff work schedule and phone numbers. LPA attempted to interview C1 but was unable. It was revealed C1 no longer lives at the facility. LPA interviewed four clients (C2-C5) who currently reside at the facility and interviewed five (S1-S5) out of eleven staff members.
Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
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 31-AS-20250418113825
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: KELLY HOUSE INC
FACILITY NUMBER: 197609302
VISIT DATE: 06/13/2025
NARRATIVE
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This is an amended copy of the report previously issued on 3/14/2025. This report supersedes reports previously issued. The findings for this complaint remain the same

Regarding the allegation, Client sustained multiple unexplained bruises: It is being alleged a staff member grabbed a client due to the client not wanting to put away their backpack when requested. As a result, the client allegedly sustained bruises. C2-C5 denied this occurred. C1 was unavailable for an interview. S1-S5 and the Administrator unanimously denied this occurred.

Regarding the allegation, Staff handled a client roughly; It is being alleged a staff member grabbed a client and “man handled” the client. C2-C5 denied this occurred. C1 was unavailable for an interview. S1-S5 and the Administrator denied this occurred.

Based upon client and staff member interviews, the allegations are unsubstantiated.

Exit interview conducted and a copy of the report was given.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2