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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610134
Report Date: 10/06/2025
Date Signed: 10/06/2025 01:48:09 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
10/01/2025 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20251001113238
FACILITY NAME:REM CALIFORNIA LLC - DONNAFACILITY NUMBER:
197610134
ADMINISTRATOR:NATASHA OCHAFACILITY TYPE:
735
ADDRESS:9512 DONNA AVETELEPHONE:
(818) 998-3161
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:4CENSUS: 4DATE:
10/06/2025
UNANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:NATASHA OCHA- AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility staff did not comply with training requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced initial complaint visit to investigate the above mentioned allegation. Upon arrival at the facility, LPA was granted access by facility staff. LPA met with Administrator Natasha Ocha and explained the purpose of the visit.During the visit, LPA requested copies of relevant documentation, including but not limited to the Staff Roster, Client Roster, and employee files for Staff #1 (S1), Staff #2 (S2), and Staff #3 (S3), as related to the investigation. A tour of the physical plant was conducted to ensure that client health and safety were being maintained and that the facility remained in compliance with Title 22 Regulations.

Allegation:Facility staff did not comply with training requirements
It was reported that S1 had worked in the facility without a valid CPI certification for 8 months, S2 worked without a valid CPI certification for 4 months, and S3 worked without a valid CPI certification for almost 3 months. Additionally, it was reported that the facility failed to maintain documentation of on-the-job training, including training materials and staff sign-in sheets. (Continue on 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025
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 3
Control Number 31-AS-20251001113238
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 - DONNA
FACILITY NUMBER: 197610134
VISIT DATE: 10/06/2025
NARRATIVE
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LPA reviewed the personnel files for S1, S2, and S3, which confirmed that:
  • S1 was employed for eight (8) months without valid CPI certification.
  • S2 was employed for four (4) months without valid CPI certification.
  • S3 was employed for approximately three (3) months without valid CPI certification.

Interview with the Administrator revealed that the Office Manager did not provide timely reminders to staff regarding CPI certification expiration dates. The Administrator further disclosed that monthly in-service training is conducted; however, documentation such as training materials and sign-in sheets had not been maintained. LPA conducted interviews with three (3) staff members, all of whom confirmed having received on-the-job training. However, due to the lack of supporting documentation, including training materials and sign-in sheets, the facility was unable to demonstrate compliance.

Based on the interviews conducted, documentation reviewed, there is sufficient evidence to substantiate the allegation that facility staff did not comply with training requirements. Therefore, this allegation is deemed Substantiated at this time.


Exit interview conducted, citation issued, appeal rights given, and copy of this report delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 31-AS-20251001113238
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 - DONNA
FACILITY NUMBER: 197610134
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2025
Section Cited
CCR
80065(f)
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(f) All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance. This requirement is not met as evidenced by
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Corrected before visit. S1, S2 and S3 had renewed their CPI training. Administrator provided training materials and sign-in sheets for staff on-the-job trainings.
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Based on record review and interview, the licensee did not comply with the section cited above. S1, S2, and S3 had expired CPI Certificates. In addition, the facility lacks supporting documentation, including training materials and sign-in sheets. This poses/posed a potential health, safety, or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025
LIC9099 (FAS) - (06/04)
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