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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609647
Report Date: 08/29/2025
Date Signed: 08/29/2025 02:54:13 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
08/22/2025 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20250822144302
FACILITY NAME:WHITE'S ADULT HOME LLCFACILITY NUMBER:
197609647
ADMINISTRATOR:WHITE, EDMONDFACILITY TYPE:
735
ADDRESS:4054 TOURNAMENT DRTELEPHONE:
(661) 526-3088
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:4CENSUS: 4DATE:
08/29/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Luis MartinezTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Staff caused injury to resident.
INVESTIGATION FINDINGS:
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13
On 8/29/2025 Licensing Program Analyst (LPA) Melissa Spaeth conducted a subsequent complaint investigation at the facility to deliver findings for the above allegation(s). LPA Spaeth met with DSP Luis Martinez. DSP Martinez confirmed there are four clients living in the facility. LPA explained the purpose of the visit was to deliver the findings. LPA Spaeth spoke to the Administrator, Edmond White via phone call. LPA toured the facility from 10:40 am until 10:50 am.

The investigation consisted of the following: On 8/27/2025, LPA Spaeth conducted an unannounced complaint investigation, interviewed the Administrator, four (4) out of four (4) staff members and interviewed three (3) out of four (4) clients.

Continued on 9099-C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2025
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-20250822144302
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: WHITE'S ADULT HOME LLC
FACILITY NUMBER: 197609647
VISIT DATE: 08/29/2025
NARRATIVE
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Regarding the allegation: Staff caused injury to a resident. It is alleged a staff member scratched a client. An interview with C1 confirmed that they were not injured by a staff member. S1-S4 also confirmed this incident did not occur. The Administrator denied the allegation. Based upon LPA’s review of the client’s records, it was revealed C1 does have self-injury behaviors.

Based upon LPA’s interviews, the allegation is 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: 08/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2