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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610108
Report Date: 04/17/2025
Date Signed: 04/17/2025 02:51:51 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.ASC, 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
04/02/2025 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20250402093547
FACILITY NAME:TIGERTAIL ADULT HOME II, INC.FACILITY NUMBER:
197610108
ADMINISTRATOR:WAULS, ASILIAFACILITY TYPE:
735
ADDRESS:2139 CORK OAK STTELEPHONE:
(661) 433-0625
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:4CENSUS: 4DATE:
04/17/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Christopher SingletonTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Staff inappropriately restrained a client while in care
Client sustained an unexplained injury while in care
INVESTIGATION FINDINGS:
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On 04/17/2025 Licensing Program Analyst (LPA) Melissa Spaeth conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA Spaeth met with the Administrator, Christopher Singleton. LPA explained the purpose of this visit was to deliver the findings.

The investigation consisted of the following: On 4/04/2025, Licensing Program Analyst (LPA) Melissa Spaeth conducted an initial complaint investigation. LPA observed the four clients at 9:10 am who were preparing to attend an adult day program. LPA reviewed clients' files at 9:10 am until 9:25 am. LPA interviewed the licensee and four (4)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
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 31-AS-20250402093547
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: TIGERTAIL ADULT HOME II, INC.
FACILITY NUMBER: 197610108
VISIT DATE: 04/17/2025
NARRATIVE
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out of eleven (11) staff members (S1-S4) at 9:25 am until 10:00 am. LPA received copies of the clients’ records, client roster, staff work schedule and staff phone numbers. LPA Spaeth interviewed one (1) out of four (4) clients at 10:00 am until 10:10 am.

Regarding the allegation, Staff inappropriately restrained a client while in care: It is being alleged a client’s arms had restraint marks that were red. S1-S4 unanimously confirmed they have never restrained a client by holding down their arms. S1-S4 also confirmed the policy of the facility is to redirect a client without using any restraints. The Licensee denied the allegation. C4 confirmed the staff have never held down their arms. LPA attempted to interview C1-C3 but was unable to due to communication barriers. During LPA Spaeth’s visit, two days following when the alleged restrain occurred, LPA observed the four clients did not have any marks on their arms.

Regarding the allegation, Client sustained an unexplained injury while in care: It is being alleged a client’s upper lip was busted. During LPA’s 4/04/2025 visit, LPA Spaeth observed the four clients did not have busted lips. S1-S4 unanimously confirmed they have never hit a client in the mouth and have never observed a client hitting another client in the mouth. C1’s documentation states C1 exhibits self-injurious behaviors. S1-S4 confirmed C1 will hit their own mouth when they are angry or upset and stated C1’s mouth will bleed. S1-S4 unanimously stated they redirect C1 and will also document the incident in the Daily Notes and Body Checklist.

LPA received copies of the reports and noted a notation was entered by staff regarding C1’s self-injuries on 4/01/2025 and 4/02/2025. C4 confirmed they have never observed a client hit themselves. LPA attempted to interview C1-C3 but was unable to due to communication barriers. The Licensee denied the allegation.

Based upon interviews conducted, LPA’s observation and the review of clients’ documentation, the allegations are unsubstantiated.

Exit Interview was conducted and a copy of this report was given.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2