197610088-1-12-2026-31-AS-MGFS-DU7SJG-20260518135509

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610088
Report Date: 01/12/2026
Date Signed: 01/12/2026 05:13:29 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
01/14/2025 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20250114101006

FACILITY NAME:	TIGERTAIL ADULT HOME 4, INC.		FACILITY NUMBER:	197610088
ADMINISTRATOR:	HALLON, CHARY		FACILITY TYPE:	735
ADDRESS:	43418 62ND STREET WEST		TELEPHONE:	(661) 433-0625
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY:	4	CENSUS: 4	DATE:	01/12/2026
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Chary Hallon - Administrator		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff make verbal threats to resident.
Staff physically assaulted resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Evelin Rios conducted an unannounced subsequent complaint visit to deliver a determinations on the above allegations. LPA was granted entry by staff and met with the Administrator, Chary Hallon and Licensee, Asalia Wauls inside. LPA explained the reason for the visit.

To investigate the allegation, on 01/22/2025, LPAs Evelin Rios and Nadia Shahbazian conducted an initial complaint visit. During the initial visit from 9:46 a.m. to 2:00 p.m., LPA conducted interviews with Client #1 (C1) and attempted interviews with two other clients (C3 and C4), who did not respond to questioning. Client#2 (C2) was out in the community. LPAs also interviewed three (3) staff and the Licensee. LPA requested copies of relevant documents pertaining to the investigation, including, but not limited to, the following: C1’s physician’s report, Individual Program Plan (IPP) from 1/11/2023, Individual Support Plan (ISP), and Special Incident Reports (SIRs) 10/2024 to 01/2025 submitted to Community Care Licensing (CCL). (Continue to LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2026

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 31-AS-20250114101006

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: TIGERTAIL ADULT HOME 4, INC.	FACILITY NUMBER: 197610088
	VISIT DATE: 01/12/2026

NARRATIVE

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(Continued from LIC9099) LPA also reviewed facilities Plan of Operation regarding Emergency Intervention Plan and Crisis Intervention Training. On 02/04/2025 LPA Rios conducted an initial complaint visit for complaint control # 31-AS-20250131102020. During that visit LPA conducted interviews with eight (8) staff of which for (4) had already been interviewed for this complaint during previous visits. LPA Rios conducted another subsequent visit on 08/04/2025 and from approximately 12:05 p.m. to 12:30 p.m., LPA interviewed the administrator, Chary Hallon and Client #2 (C2). On 10/06/2025 LPA interviewed the Behavior Consultant from Mountain Light, Inc. regarding facility’s communication with them.

Allegation: Staff make verbal threats to residents. It was alleged that Client #1 (C1) contacted emergency services, and when they arrived staff told the paramedics that C1 was fine and later threatened to assault C1 if they attempted to call again.

Interview with C1 supported the allegation stating that after an incident with S1, Staff#1 (S1) was upset C1 had contacted 911 and then threaten to assault C1 if C1 called 911 again. Interview with eight (8) staff denied witnessing C1 being threatened by S1. LPA’s Interview with S1 denied the allegation. Interview, C2 denied witnessing S1 threaten C1. Review of Special Incident Reports (SIRs) regarding C1 from 10/2024 to 01/2025 revealed C1 had episodes of verbal aggression and making threats about reporting staff. C1’s IPP revealed C1 has disruptive behaviors that interfere with social participation almost every day. LPAs interview with staff and C2 corroborate C1 threatens staff and uses profanity towards staff and other clients. LPA reviewed the information documented in the complaint intake, which included a report from Deputy Mendoza of the Lancaster Sheriff’s Department. According to the report dated 01/15/2025, Deputy Mendoza responded to the facility regarding resident C1. He spoke with C1, who stated they were fine, enjoyed living at the facility, and did not require any assistance from the deputy. Deputy Mendoza also spoke with a staff member who reported being unaware of any incident or concerns. No additional information was provided.

LPA was unable to find a witness to the allegation that S1 threatened to assault C1 if they contacted 911 again. Therefore, based on interviews, and document reviews, this allegation is deemed Unsubstantiated at this time.

(Continue to LIC9099-C) Page 2 of 3

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20250114101006

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: TIGERTAIL ADULT HOME 4, INC.	FACILITY NUMBER: 197610088
	VISIT DATE: 01/12/2026

NARRATIVE

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Allegation: Staff physically assaulted resident. It was alleged that on different occasions staff physically assaulted Client #1 (C1).

LPA’s, interview with C1 supported the allegation. According to C1 during separate incidents staff did not exercise restraint when conducting CPI holds. According to C1 during one incident Staff #1 (S1), without prior warning, grabbed C1 and dropped C1 to the floor and kept asking C1 if they were relaxed. When LPA asked what was happening prior to the incident C1 stated they were going back and forth with S1. During another incident, C1 reported that Staff #2 (S2) tripped C1, causing C1 to fall to the floor, and then held C1 down by placing a knee on C1’s back while asking if C1 was relaxed. When asked what happened prior to the incident, C1 stated that S2 believed C1 had hit C3. C1 reported that these incidents occurred in November and December.

LPA review of Special Incident Reports revealed two incidents matching events described by C1. On 12/04/2025 the facility reported S1 conducted a CPI hold with Staff #3 (S3) present. LPA’s interview with staff present revealed that C1 was yelling at another staff member who was cleaning the windows by the dining area. C1 was using profanity and when S1 attempted to redirect C1, C1 started to engage in verbal aggression and spit towards S1. Interview with S1 corroborates C1 was cursing at another staff cleaning and when C1 started to spit, S1 conducted a CPI hold. LPA's review of staff training revealed they had up to date CPI training. Review of incident report that occurred on 09/10/2024 revealed C1 was exhibiting aggressive behavior towards other clients in the facility and S2 attempted to redirect C1. C1 attempted to throw hand sanitizer at staff that ended up on the floor and C1 slipped. When C1 slipped S2 slipped with C1. Staff present deny that a CPI hold was used for this incident. Staff present deny S2 dropped C1 on purpose. LPA's interview with Behavior Consultant revealed facility reports incidents of CPI holds and tracks client's behavior that is reported to them.

LPA was unable to find corroborating witnesses to the allegation that staff physically assaulted resident. Therefore, based on interviews, and document reviews, this allegation is deemed Unsubstantiated at this time.

No health or safety issues observed. Exit interview conducted. Copy of report provided.

(Page 3 of 3)

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3