197609963-2-4-2026-29-AS-KHEN-DSM72W-20260328211724

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609963
Report Date: 02/04/2026
Date Signed: 02/04/2026 04:17:25 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
01/30/2026 and conducted by Evaluator Christine Yee

COMPLAINT CONTROL NUMBER: 29-AS-20260130113731

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:	02/04/2026
		UNANNOUNCED	TIME BEGAN:	11:39 AM
MET WITH:	Hector Gomez, Administrator		TIME COMPLETED:	04:25 PM

ALLEGATION(S):

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Resident sustained unexplained injury due to abuse or neglect while in care.

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, Administrator. The reason for today's visit was provided.

On today's visit, interviews were conducted with Hector Gomez, Administrator at 12:00pm, Staff #1 at 2:00pm and Resident #1 at 12:42PM. Resident #1's file were also reviewed and copies of documents were obtained during the visit.

Per the information received from interviews conducted during today’s investigation, Resident #1 has lived at this facility since May 2011. Per review of facility files, Resident #1 is diagnosed with hypertension, Type 2 diabetes and schizoaffective disorder and is on multiple psychotic medications. Resident #1 is very fearful,

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2026

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 3

Control Number 29-AS-20260130113731

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: 02/04/2026

NARRATIVE

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anxious, delusional and may be hearing voices, paranoid, severely depressed, hallucinations and suicidal thoughts. Resident #1 also has insomnia and has difficulty sleeping and does not sleep for days and is self-destructive and hits their head on the wall. In the past year, Resident #1 has been hospitalized in the Psychiatric Unit twice for major depression, sleep deprivation, agitation, anxiety, suicidal ideation and hitting their head on the wall. Resident #1 has had mental illness issues since they have lived here and has not had any other issues with staff or other residents.

The facility accepts residents who are funded by an Assisted Living Waiver Program(ALWP) and on January 29, 2026, the nurse from that agency called the Administrator to check on their 6 clients and used Face Time to conduct a wellness assessment of the 5 residents living at the facility. The sixth resident could not be interviewed as they were away from the facility. Resident #1 is one of their clients. Per the Administrator, Resident #1 was given the phone while the Administrator stepped out to give them privacy. During the short private telephone conversation, Resident #1 told the agency personnel in Spanish that “the people in Hollywood are hitting me” and “the Nicaraguans beat me up every day”. When Resident #1 returned the phone to the Administrator, they kept repeating the same thing. Per the Administrator, he explained the type of clients that reside at the facility and Resident's delusions and behavior to the nurse. He also told the nurse that he understood if she had to cross report as a mandated reporter.

Per review of medical reports generated by medical personnel during their monthly visits with Resident #1, they are also told by Resident #1 that they are being attacked by people that come into their room and they are in pain. Per Resident #1, it was reported to staff but no one can see them. On today's visit, LPA Yee was told by Resident #1 via a staff who translated that the Nicaraguans cut their feet with stones. When asked where do they cut their feet and it was indicated that they cut their toes but no blood is seen. Resident #1's toes were observed. Resident #1 also told LPA Yee that the Nicaraguans were here and kicked them in the face and the head this morning around 10am. However, the staff translator said that they saw Resident #1 getting coffee and cookies at that time. The story changed that the Nicaraguans kicked them during the coffee break. LPA Yee did not observe any injuries or bruises on Resident #1's face, head, scars on the

Continued on LIC9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2026

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20260130113731

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: 02/04/2026

NARRATIVE

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bottom side of their feet or any missing toes. Resident #1 also stated that the people from Hollywood cut their feet but they still have their feet because God helps them. Per Resident #1, they want to move to Pasadena because that is where they used to live and so that the people in Hollywood and the Nicaraguans don't know where they are. Resident #1 did not any time during the interview state that staff or any other resident was abusing them. They want to move promptly.

Per interview with the Administrator, when Resident #1 goes to the hospital, they tell the ambulance personnel, intake person, nurse that they do not want to return to the facility and when the resident is ready to be discharged they tell the social worker that they want to go back to the facility after their hospital stay. The relocation has also been discussed with the funding agency and they have not followed through because Resident #1 changes their mind.

Based on the interviews conducted and file review there is insufficient evidence to support the allegation that Resident sustained unexplained injury due to abuse or neglect while in care.

Although the allegation 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: 02/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2026

LIC9099 (FAS) - (06/04)

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