197609963-12-17-2025-29-AS-KHEN-DQS29A-20260128161137

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609963
Report Date: 12/17/2025
Date Signed: 12/17/2025 05:01:16 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
12/11/2025 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20251211115037

FACILITY NAME:	VALLEY MANOR GUEST HOME		FACILITY NUMBER:	197609963
ADMINISTRATOR:	MARTY BACON		FACILITY TYPE:	735
ADDRESS:	6130 VINELAND AVE		TELEPHONE:	(818) 766-8161
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY:	58	CENSUS: 51	DATE:	12/17/2025
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Hector Gomez, Administrator		TIME COMPLETED:	05:05 PM

ALLEGATION(S):

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1. Staff do not prevent a client from causing harm to another client
2. Staff behavior poses as a risk to a client
3. Staff allowed a client to sleep outside of the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegations and met with Hector Gomez, Administrator. Stephen Manalo, Administrative Assistant and Business Manager, also participated in today's visit. The reason for today's visit was explained.

On today's visit, LPA Yee conducted an interview with the Administrator at 10:35am and throughout the visit, Witness #1 at 11:27am, Witness #2 and Witness #3 at 12:36pm, Client #2 at 1:47pm and Staff #1 at 1:50pm. Attempts to contact Client #1 via telephone was unsuccessful. LPA Yee also conducted a tour of bedroom #109 at 1:56pm.
Per information received on today's visit regarding allegation #1 that Staff do not prevent a client from causing harm to another client, the client who is specifically named as being the person who is physically

continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20251211115037

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: 12/17/2025

NARRATIVE

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intimidating, threatening and yelling at Client #1 in their room, is not a client at this facility. Per review of the facility's client roster and per interview with the Administrator, they do not have any client with the name provided for the alleged perpetrator. However, there is a staff that works for the contracted FSP Program that is located on site with the name provided for the alleged perpetrator. Per interview conducted with the Staff (Witness #1), they deny that they have intimidated, threatened or yelled at Resident #1 or any resident in the facility. Per Witness #1, they are usually accompanied by facility staff if they need to speak with Client #1 or any resident who is a client of the FSP Program. Witness #1 usually makes contact with Resident #1 when the client has a doctor appointment or is reminded to attend day program or any scheduled appointments. Per interview conducted with Client #2, roommate of Client #1, also confirms that they have never observed or witnessed any incidents where Client #1 was being physically intimidated, threatened or yelled at by anyone in the room. Per interviews conducted with the Administrator, Administrative Assistant, Witness #2 and Witness #3, they have never been approached by Client #1 or any facility clients or advised of any such issues going on at the facility and nothing needed to be addressed. Based on the information received on today's visit, there is insufficient evidence obtained to support the allegation that the staff did not prevent a client from causing harm to another client as there is no facility client with the name provided as being the perpetrator, therefore the allegation is unsubstantiated at this time.

Regarding allegation #2, Staff behavior poses as a risk to a client, information received from interviews conducted, Staff do not ignore any complaints of physical intimidation, threats or yelling at clients. Per the Administrator, if the staff observe any such activity or are made aware by the residents, they report the information to the Administrator and he addresses it. Client #1 has never reported any threats of physical violence or any inappropriate contact by another client to staff of the facility or to the staff at the FSP Program to allow them to address their concerns. Per all parties interviewed, Client #1 is hardly at the facility and refuses to participate in the FSP Program requirements. Client #1 has disengaged from the program. Per information provided, Client #1 is present at the facility about 20% of the time in one week. Medications are sent with Client #1 when client does home visits ard the containers are returned empty. Facility staff and the staff of the FSP Program are not certain that the medications are being taken. Per information received on

continued on LIC9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20251211115037

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: 12/17/2025

NARRATIVE

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today's visit, there is insufficient evidence to support the allegation that staff behavior poses a risk to a client, therefore the allegation is unsubstantiated at this time.

Per information received regarding Allegation #3 - Staff allowed a client to sleep outside of the facility, the Administrator vehemently stated that the staff do not allow residents to sleep outside the facility. The staff will wake the resident up and suggest that they go to their room. They also ask the residents if they are okay if they are observed dozing off. Per interviews conducted, no one has observed Client #1 sleeping outside when they are present at the facility. Client #1 spends a lot of time at a friend's place since the friend moved out in July 2025. Based on the information received from the interviews conducted on today's visit, there is insufficient evidence to support the allegation that staff allowed a client to sleep outside the facility, therefore the allegation is unsubstantiated at this time.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur.

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: 12/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025

LIC9099 (FAS) - (06/04)

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