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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610449
Report Date: 11/21/2024
Date Signed: 11/21/2024 04:01:39 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.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
11/20/2024 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20241120082431
FACILITY NAME:EXCELLENCE COMMUNITY RESIDENTIAL PROPERTIES 2FACILITY NUMBER:
197610449
ADMINISTRATOR:ASKEW, OCTAVIAFACILITY TYPE:
735
ADDRESS:4369 PORTOLA DRTELEPHONE:
(424) 789-0439
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:4CENSUS: 1DATE:
11/21/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Octavia AskewTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff are not interacting with resident in an appropriate manner
INVESTIGATION FINDINGS:
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On 11/21/2024, Licensing Program Analyst (LPA) Melissa Spaeth and Licensing Program Manager (LPM) Troy Agard initiated a complaint investigation for the allegation(s) listed above. LPA and LPM were greeted by the Licensee Octavia Askew. LPA Spaeth explained the purpose of this visit is to investigate the complaint allegation(s). LPA Spaeth toured the facility and did not observe any issues.

LPA Spaeth and LPM Agard interviewed the Administrator (S1) at 11:00 am until 12:00 pm. LPA Spaeth requested copies of a client’s documents. LPA received the documentation. LPA Spaeth interviewed two staff members (S2-S3) out of eight staff members at 12:00 until 12:20 pm.
Continued 9099-C


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
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-20241120082431
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: EXCELLENCE COMMUNITY RESIDENTIAL PROPERTIES 2
FACILITY NUMBER: 197610449
VISIT DATE: 11/21/2024
NARRATIVE
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Regarding the allegation: Staff are not interacting with resident in an appropriate manner. It’s alleged that facility staff were recording a client and threatening to post on social media. S1-S3 denied this occurred. C1 was unavailable for an interview.

Based upon staff interviews, the allegation is unsubstantiated.

Exit interview conducted and a copy of the report was given

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

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2