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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610134
Report Date: 10/30/2025
Date Signed: 10/31/2025 07:51:54 AM

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
10/21/2025 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20251021010849
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:
10/30/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:NATASHA OCHA- AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff are not allowing a resident to have access to the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced initial complaint visit to investigate the allegation mentioned above. LPA met with Administrator Natasha Ocha and explained the purpose of the visit. 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. LPA requested copies of the Staff Roster, Client Roster, Client#1 (C1) folder, and other documents pertinent to the investigation.

Allegation: Staff are not allowing a resident to have access to the facility.
It was alleged that Client #1 (C1) did not have access to the facility due to short staffing on October 16, 2025. LPA interviewed the Administrator and three staff members, and attempted to interview C1. The administrator denied the allegation. The Administrator stated that on October 16, 2025, Client #2 (C2) had a doctor’s appointment, and two staff members were scheduled to assist both C1 and C2.
(Continue on 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
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-20251021010849
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: 10/30/2025
NARRATIVE
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C1 did not object to going out; however, there were no staff available to remain at the facility in case C1 changed his/her mind and wished to stay. LPA advised the Administrator that facility personnel must be competent to provide the services necessary to meet the clients needs at all times. LPA reviewed the staff schedule and confirmed that only two staff members were assigned to assist C1 and C2 during the morning shift. Interviews with staff confirmed that there were no contingency plans in place in the event a client chose to remain at the facility while others were off-site. Based on the information obtained, the 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: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20251021010849
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: 10/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2025
Section Cited
CCR
80065(a)
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Personnel Requirements. (a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement is not met as evidenced by:
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The Administrator will provide a contingency plans in the event a client chose to remain at the facility while others were off-site by the POC date.
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 Based on information obtained, the licensee did not comply with the section cited above. There were no contingency plans in place in the event a client chose to remain at the facility while others were off-site.This poses a potential health, safety or personal rights risk to residents 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: 10/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3