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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610211
Report Date: 06/18/2025
Date Signed: 06/18/2025 01:45:54 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.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
06/12/2025 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20250612121844
FACILITY NAME:KITTRIDGE RCFEFACILITY NUMBER:
197610211
ADMINISTRATOR:MARTIR, FRANCISFACILITY TYPE:
740
ADDRESS:20702 KITTRIDGE STTELEPHONE:
(818) 854-6745
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:6CENSUS: 5DATE:
06/18/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Michael CustodioTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff hit resident with an object.
INVESTIGATION FINDINGS:
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On 06/18/25 Licensing Program Analyst (LPA) Lorena Casillas conducted an unannounced complaint visit to investigate the above stated allegation. LPA was greeted by staff and allowed entry. Staff member called back up Administrator, Michael Custodio and advised them of LPA visit. Administrator arrived shortly after, and an entrance interview was conducted.

From 11:00 am to 1:30 pm LPA toured the facility, conducted interviews, reviewed staff and resident files. LPA collected LIC500, Resident Roster, Liability Insurance and Administrator certificate. LPA also requested copies of resident records and any other documents pertaining to the investigation.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
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-20250612121844
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: KITTRIDGE RCFE
FACILITY NUMBER: 197610211
VISIT DATE: 06/18/2025
NARRATIVE
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Allegation: Staff hit resident with an object.

It is alleged that staff hit a resident with an object. Regarding this allegation it is reported that staff member #1 (S1) hit resident #1 (R1) with a broom stick. LPA interviewed Back Up Administrator who indicated having no knowledge of the incident and denied that such incident happened. LPA spoke to Administrator Francis Martir over the phone who also stated that they have no knowledge of the incident and also denied the allegation. Administrator Francis stated that a county nurse inquired about R1 via text, where the nurse asked about R1’s wellbeing but did not report to Administrators or facility staff, any incidents. Furthermore, Administrators both report that R1 and S1 get along well and that no other residents have reported anything relating to S1’s behavior towards them. LPA interviewed S1 who also denied the allegation stating that they would never hit anyone, let alone a resident. LPA was able to interview five (5) out of five (5) residents who stated collaboratively that S1 is good to them, and they have no issues with any of the staff in the facility. Two (2) out of the five (5) residents stated that they have heard R1 yell at the staff but also state that this is a means for R1 to communicate with staff sometimes. All residents expressed being happy and satisfied with the services and care provided by the staff. It was also reported to LPA by all residents that they have not witnessed anyone getting hit or struck by any objects, nor have they been subject to any physical abuse. LPA interviewed R1 and R1 revealed that they made the incident up and that R1 is not sure why they lied but assured that S1 did not hit R1 with a broom or any object. R1 stated that they did not report anything to anyone to their recollection. Furthermore, R1 stated that they get along well with all the staff to include S1 and reiterated that they do not have any concerns with any of the staff at the facility. LPA interviewed staff member present, and they denied the allegation. Staff also stated that they have not witnessed any residents being stuck or hit with any objects by anyone. Therefore, based on interviews, record reviews and observations, this allegation is deemed unsubstantiated.

No citation issued. Exit interview conducted. Copy of report given to Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2