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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610126
Report Date: 11/25/2024
Date Signed: 11/25/2024 03:48:34 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
11/18/2024 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20241118112303
FACILITY NAME:LAUREL HOMEFACILITY NUMBER:
197610126
ADMINISTRATOR:ALEX ESPINOZAFACILITY TYPE:
737
ADDRESS:41447 W 25TH STREETTELEPHONE:
(661) 947-9612
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:4CENSUS: 4DATE:
11/25/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Alex EspinozaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not report incident (s) to authorized representatives in a timely manner
INVESTIGATION FINDINGS:
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On 10/25/2024 Licensing Program Analyst (LPA) Melissa Spaeth initiated a complaint investigation for the allegation(s) listed above. LPA was greeted by the back up administrator, Vladimir Bando. The Administrator, Alex Espinoza arrived at 11:50 am.

LPA Spaeth toured the facility at 10:50 am until 11:05 am and did not observe any safety issues. LPA requested copies of email documentation and LPA received the documentation during the visit.

Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
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-20241118112303
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: LAUREL HOME
FACILITY NUMBER: 197610126
VISIT DATE: 11/25/2024
NARRATIVE
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Regarding the allegation: Staff did not report incident(s) to authorized representatives in a timely manner. It’s being alleged the facility did not report the physical restraining of a client to authorized representatives in a timely manner. The Administrator and Back-up Administrator provided copies of the emails sent to the authorized representatives which proves the representatives were notified.

Based upon the evidence provided, the allegation is unsubstantiated.

Exit interview conducted and a copy of the report was given.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2