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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610130
Report Date: 11/20/2025
Date Signed: 11/20/2025 02:05:35 PM

Substantiated


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
11/19/2025 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20251119123138
FACILITY NAME:REM CALIFORNIA LLC - BAIRDFACILITY NUMBER:
197610130
ADMINISTRATOR:JONATHAN A WATTSFACILITY TYPE:
735
ADDRESS:10426 BAIRD AVETELEPHONE:
(818) 363-3333
CITY:NORTHRIDGESTATE: CAZIP CODE:
91326
CAPACITY:4CENSUS: 3DATE:
11/20/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jonathan Watts- AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not provide proper supervision to client in care resulting in the client leaving the facility unassisted
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced initial complaint visit to investigate the above stated allegation. LPA arrived at the facility and was granted access by Administrator Jonathan Watts. LPA requested copies of pertinent information, which include, but are not limited to, Staff Roster, Clients Roster, Client#1's (C1) file, and Staff#1's (S1)file. LPA conducted a physical plant tour to ensure the health and safety of the clients are protected and the physical plant complies with Title 22 Regulations

Allegation: Staff did not provide proper supervision to a client in care, resulting in the client leaving the facility unassisted.

It was reported by another agency, during its routine review of the Special Incident Report (SIR) dated October 10, 2025, that Resident 1 (R1) had eloped from the home while under the supervision of Direct Support Professional 1 (DSP 1).
(Continue on 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
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-20251119123138
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: REM CALIFORNIA LLC - BAIRD
FACILITY NUMBER: 197610130
VISIT DATE: 11/20/2025
NARRATIVE
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On October 11, 2025, Community Care Licensing (CCL) received an SIR from Facility Administrator Jonathan Watts, reporting that Client #1 (C1) was AWOL from the facility. On October 22, 2025, LPA Agban conducted a case management visit to investigate the incident. LPA interviewed the Administrator, and it was confirmed that C1 had eloped from the facility while Staff #1 (S1) was using the restroom. The Administrator stated that on the day of the incident, only one staff member (S1) was present with C1. The facility was cited with civil penalties and was given a Plan of Correction. During today’s visit, the LPA interviewed four staff members and one out of three clients. The allegation is deemed substantiated, and the Plan of Correction is cleared.

Exit interview conducted, copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2