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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610361
Report Date: 10/29/2025
Date Signed: 10/29/2025 03:48:06 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.ASC, 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
08/29/2025 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20250829095612
FACILITY NAME:LIBERTY RESIDENTIAL FACILITYFACILITY NUMBER:
197610361
ADMINISTRATOR:LATANYA DAVISFACILITY TYPE:
735
ADDRESS:3330 RACQUET LANETELEPHONE:
(661) 916-9090
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:4CENSUS: 3DATE:
10/29/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Tanika GreenTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff did not meet the minimum qualifications required
Staff did not conduct disaster drills
INVESTIGATION FINDINGS:
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On 10/29/2025 Licensing Program Analyst (LPA) Melissa Spaeth conducted a subsequent complaint investigation at the above facility to deliver findings for the above allegation(s). LPA Spaeth met with staff member Tanika Green. LPA explained the purpose of the visit was to deliver the findings.

The investigation consisted of the following: On 9/04/2025, LPA Melissa Spaeth initiated a complaint investigation for the allegation(s) listed above. LPA met with the Administrator and toured the facility at 11:00 am until 11:15 am. On 10/17/2025, LPA Spaeth conducted a subsequent complaint investigation and reviewed the staff records and the fire drill records. LPA received copies of the records. LPA interviewed two out

Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
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-20250829095612
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LIBERTY RESIDENTIAL FACILITY
FACILITY NUMBER: 197610361
VISIT DATE: 10/29/2025
NARRATIVE
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of three clients (C1-C2) on 10/24/2025 at 2:00 pm until 2:15 pm and interviewed four out of eleven staff members (S1-S4) and the Administrator on 10/24/2025 at 2:30 pm until 3:30 pm.

Regarding the allegation: Staff did not meet the minimum qualifications required. It is alleged a staff member did not complete the Direct Support Professional training (DSP 1) within the first twelve months of employment. LPA reviewed the North Los Angeles County Regional Center’s Corrective Plan issued 8/20/2025 which confirmed the allegation. During a file review, LPA observed S1 was hired February, 2024 but had not completed DSP training within the designated time.

Regarding the allegation: Staff did not conduct disaster drills. It is alleged only one earthquake drill was conducted on May 26, 2025. Upon reviewing the quarterly fire drill/emergency evacuation records, LPA observed there were no records between 12/16/2024 and 2/10/2025. One staff member S3 confirmed fire drills were conducted every three months between 12/16/2024 to 2/10/2025 but was aware the documentation was missing. S1-S3 could not remember. The Administrator confirmed the documents was missing. The two clients (C1-C2) were unable to confirm quarterly fire drills occurred between 12/16/2024 to 2/10/2025.

Based upon record review and interviews of staff and clients, the allegations are substantiated.

Exit interview conducted, appeal rights discussed, and a copy of the report was given.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
LIC9099 (FAS) - (06/04)
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Control Number 31-AS-20250829095612
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LIBERTY RESIDENTIAL FACILITY
FACILITY NUMBER: 197610361
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/29/2025
Section Cited
CCR
80078(a)
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80078 Responsibility for Providing Care & Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs.
This requirement is not met as evidenced by:
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LPA reviewed staff records and observed staff member one completed the training as of 10/17/2025.
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Based on review of staff records, the licensee failed to ensure a staff member had completed the DSP 1 training within the first 12 months of employment which could pose a potential health, safety or personal rights risk to persons in care.
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Type B
11/04/2025
Section Cited
HSC
1531.1(j)
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1531.1 Residential facilities with persons having developmental disabilities…(j) Emergency fire and earthquake drills shall be conducted at least once every 3 months on each shift…
This requirement is not met as evidenced by:
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The Licensee will provide documentation to LPA Spaeth confirming when the fire & earthquake drills will be conducted for the next six months. The Licensee will send the documentation via email to LPA Spaeth.
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Based on LPA’s review of facility records, the licensee did not comply with the section cited above. The facility failed to provide documentation confirming fire & earthquake drills were conducted between 09/2024 & 02/02/2025 which could pose 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: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
LIC9099 (FAS) - (06/04)
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