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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609963
Report Date: 02/03/2025
Date Signed: 02/03/2025 05:33:12 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/30/2025 and conducted by Evaluator Christine Yee
COMPLAINT CONTROL NUMBER: 29-AS-20250130161852
FACILITY NAME:VALLEY MANOR GUEST HOMEFACILITY NUMBER:
197609963
ADMINISTRATOR:MARTY BACONFACILITY TYPE:
735
ADDRESS:6130 VINELAND AVETELEPHONE:
(818) 766-8161
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:58CENSUS: 53DATE:
02/03/2025
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Hector Gomez, AdministratorTIME COMPLETED:
05:40 PM
ALLEGATION(S):
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Staff did not provide proper supervision to residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and met with Hector Gomez, Assistant Administrator. The reason for today's visit was explained.

On today's visit LPA Yee conducted an interview with the Assistant Administrator at 11:40am, conducted a visit together with the Assistant Administrator to the Nursing and Transistional Home located next door at 12:45pm and interviewed the Reporting Party at 1:50pm. Prior to conducting the visit to the facility, LPA Yee conducted a tour of the Laundromat located at 6024 Vineland Avenue at 11:10am.

Per information provided on the complaint, the residents of the facility are hanging out in front of the laundromat and going inside asking for money and food. It is also alleged that in the last couple of days
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025
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 29-AS-20250130161852
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: VALLEY MANOR GUEST HOME
FACILITY NUMBER: 197609963
VISIT DATE: 02/03/2025
NARRATIVE
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a resident of the facility has been violently banging on the windows of the Laundromat. It is also alleged that a female resident assaulted the owner of the Laundromat in July 2024 and was tasered and arrested by the police. Per the Assistant Administrator they did not have any missing persons or was aware of any one that was missing as a result of the arrest. Per the description provided by the Reporting Party, the woman violently banging on the Laundromat window, has bright red hair and is wearing a bright pink jacket. Per information provided by the Assistant Administrator, he received a telephone call from a gentleman about a week ago around 10:30/11:00am advising him that there was a lady banging on the Laundromat window. Per the Assistant Administrator, he did tell the caller that he could call the police if it became necessary. Initially he thought it was one of their residents but the resident was in their room sleeping. Per the Assistant Administrator, he drove over to the Laundromat and he did not bother to go in when the woman he observed was determined not to be one of the facility resident. He turned around in the driveway located between the Laundromat and the liquor store and came back.
LPA Yee and the Assistant Administrator conducted a visit at 12:45pm to the nursing home located next door to the facility, in the hopes of locating the woman with red hair. A picture of the woman was also shown to staff. Per the next door staff, the woman has been observed out in the community, but is also not a resident of theirs.

Per the tour of the Laundromat conducted today, inside and outside, at 11:10am, LPA Yee did not observe anyone, including the red haired woman, that could be identified as a facility resident.

Per information obtained from the tour of the Laundromat, the visit to the nursing home and interview with the Assistant Administrator, there was insufficient evidence to support the allegation that Staff did not provide proper supervision to residents, therefore the allegation is unsubstantiated at this time.


Exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2