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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609688
Report Date: 01/13/2026
Date Signed: 01/13/2026 12:27:20 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
01/07/2026 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20260107223954
FACILITY NAME:ZION ETERNITY RESIDENTIALFACILITY NUMBER:
197609688
ADMINISTRATOR:CHARLES CHANTAWANSRIFACILITY TYPE:
735
ADDRESS:43642 DANA DRTELEPHONE:
(818) 687-3830
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:4CENSUS: 4DATE:
01/13/2026
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Charles ChantawansriTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff yelled at a client
Staff handled a client in a rough manner
INVESTIGATION FINDINGS:
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On 01/13/26 at 08:40 am, Licensing Program Analyst (LPA) Lorena Casillas conducted an unannounced 10-day complaint visit to the facility to investigate the above mentioned allegations. LPA was greeted and granted access to the facility by staff. LPA met with Administrator, Charles Chantawansri and LPA explained the reason for the visit. Entrance interview was conducted.

At 09:00 am, LPA conducted a physical plant tour to ensure the health and safety of the clients are protected. At approximately 09:15 am, LPA requested copies of client and staff rosters, surety bond and Administrator Certificate. LPA also requested copies of any documents relevant to the investigation. At approximately 09:30 am LPA conducted a file review of documents provided. Between 09:30 am and 12:30 pm, LPA conducted interviews with Administrator, four (4) staff, four (4) out of four (4) clients and one (1) witness.

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

DATE: 01/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2026
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 2
Control Number 31-AS-20260107223954
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: ZION ETERNITY RESIDENTIAL
FACILITY NUMBER: 197609688
VISIT DATE: 01/13/2026
NARRATIVE
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Allegation: Staff yelled at a client.

It is alleged that staff yelled at a client. Regarding this allegation it is reported that on 01/02/26 Staff #1 (S1) yelled at Client #1 (C1) while C1 was having a behavioral episode. LPA interviewed Administrator who stated that this incident is unknown to them, adding that staff have not reported or documented anyone yelling at clients. Administrator also stated that they have not witnessed any staff members yell at the clients, denying this allegation. Administrator revealed that on 01/02/26 C1 was having a behavior however denied that any staff did anything inappropriate and referred to their training to de-escalate the situation. LPA interviewed four (4) out of four (4) staff members present at the facility and they all denied the allegation stating that they have not yelled at clients nor have they witnessed anyone yell at the clients. LPA interviewed C1, who denied the allegation. Client #2 also denied the allegation. Two (2) clients could not verbally communicate with LPA. LPA interviewed Witness #1 (W1), a Registered Behavioral Technician/Senior Conduct Specialist Supervisor familiar with the alleged incident and W1 stated that this incident was not reported to them and that they have not witnessed any staff yell at clients. Based on observations, interviews and record reviews this allegation is deemed unsubstantiated.

Allegation: Staff handled a client in a rough manner.

It is alleged that staff handled a client in a rough manner. Regarding this allegation it is reported that on 01/02/26 Staff #1 (S1) pushed Client #1 (C1) out of the way. LPA interviewed Administrator who denied this allegation stating that they have not witnessed any staff pushing or harming any clients. Administrator also stated that all staff go through training and are aware of how to de-escalate a behavior and that in no way is pushing a client allowed. LPA interviewed four (4) out of four (4) staff present and they all denied the allegation stating that they have not pushed or witnessed anyone push any of the clients. Furthermore, the staff directed LPA to their daily notes where all staff record individual client daily activities. LPA reviewed daily notes and could not find any reports of staff having to intervene with physical touch towards clients. LPA was able to find that an incident for 01/02/26 was reported via Special Incident Report (SIR) to Community Care Licensing (CCL), where C1 had a behavior that was verbally de-escalated. LPA interviewed Witness #1 (W1), a Registered Behavioral Technician/Senior Conduct Specialist Supervisor familiar with the alleged incident and W1 stated that this incident was not reported to them and that they have not witnessed any staff handling any clients in a rough manner. Therefore, based on interviews, observations and record reviews this allegation is deemed unsubstantiated.

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

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

DATE: 01/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2