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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610235
Report Date: 10/23/2025
Date Signed: 10/23/2025 12:00:06 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
10/20/2025 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20251020143321
FACILITY NAME:WYSE HOMEFACILITY NUMBER:
197610235
ADMINISTRATOR:DAVIS, LA QUENCIAFACILITY TYPE:
737
ADDRESS:35158 WYSE ROADTELEPHONE:
(626) 500-1430
CITY:SANTA CLARITASTATE: CAZIP CODE:
91390
CAPACITY:4CENSUS: 1DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:La Quencia DavisTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility staff did not follow reporting requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an initial complaint visit to investigate the allegation mentioned above. LPA met with Administrator LaQuencia Davis who was informed of the reason for the visit.

On 10/21/2025, (LPA) received a complaint alleging that facility staff did not follow reporting requirements. On 10/22/2025, from 9:30 a.m. to 10:30 a.m., LPA reviewed the complaint and documents related to the allegation. On 10/23/2025, from 10:00 a.m. to 12:30 p.m., LPA conducted an initial complaint visit and met with Administrator LaQuencia Davis, who was informed of the reason for the visit. During the visit, LPA conducted a physical plant inspection, reviewed facility documents, and conducted interviews with relevant parties.Information obtained revealed that on 10/13/2025, at approximately 1:00 p.m., Client #1 (C1) became aggressive and attempted to attack staff. During the escalation, C1 chased staff outside the facility. Other staff intervened and utilized a Pro-Act wall and floor restraint to deescalate the situation. The Administrator confirmed that the restraint reporting was one day late to Regional Center in accordance with
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
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-20251020143321
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: WYSE HOME
FACILITY NUMBER: 197610235
VISIT DATE: 10/23/2025
NARRATIVE
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Title 17 reporting requirements, due to having computer and fax machine issues. It was also confirmed, the SIR was not submitted to Licensing. The restraint report was eventually sent to Regional Center, and during today’s visit, LPA obtained a copy of the SIR for Licensing. Based on interviews and documentation reviewed, the allegation that staff did not follow reporting requirements is Substantiated.

Citation issued, appeal rights, exit interview, and copy of report given to Administrator.

**Note, citation issued during today's visit, will be cleared. The Administrator submitted a copy of the SIR and LPA received missing reports for the year of 2025. Administrator was informed that moving forward, all SIRs are to be emailed to Licensing, using the office email address or fax number.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20251020143321
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: WYSE HOME
FACILITY NUMBER: 197610235
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/23/2025
Section Cited
CCR
80061(b)
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Reporting Requirements: (b) Upon the occurrence...(1) below, a report shall be made to the licensing agency within the agency's next working day during its normal business hours... a written report containing the information specified in (2) below shall be submitted to Licensing agency within
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During the visit, the Administrator submitted to LPA a hard copy of the SIR for the incident that occurred 10/13/2025 with C1 and staff. LPA also received all SIRs for the 2025 year until current date. Administrator was provided the RO's office email address and fax number. Moving forward the
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seven days. This requirement was not met, evidenced by, based on interviews and documentation, the Administrator did not submit a SIR to Licensing for an incident that occurred at the facility. This is a potential health and safety risks to clients in care.
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Administrator was made aware that reports are to be sent using office email or fax.
POC cleared during the visit.
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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: Naira Margaryan
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
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