<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610497
Report Date: 02/11/2026
Date Signed: 02/11/2026 03:34:52 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/09/2026 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20260209111014
FACILITY NAME:AMEND TREATMENT - PORTSHEADFACILITY NUMBER:
197610497
ADMINISTRATOR:JAYDEN BEVANFACILITY TYPE:
772
ADDRESS:6766 PORTSHEAD ROADTELEPHONE:
(805) 912-6363
CITY:MALIBUSTATE: CAZIP CODE:
90265
CAPACITY:6CENSUS: 5DATE:
02/11/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Mathew Levison, Director of HospitalityTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not reporting incidents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At 10:00am, Licensing Program Analyst (LPA), Angela Panushkina conducted an unannounced visit in response to the above-mentioned allegation. LPA met with the Director of Hospitality and a Therapist and explained the reason for the visit.

At 10:05am, LPA requested residents and staff roster. At 10:10am, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, relevant to the investigation. LPA also requested a copy of facility's Reporting Policy and Procedures but was informed that no documents are available, at this time. At approximately 10:20am, LPA conducted a physical plant tour. Between 10:25am – 01:00pm, LPA conducted an interview with the Director of Hospitality and a Therapist, two (2) staff, and four (4) clients.

Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026
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-20260209111014
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: AMEND TREATMENT - PORTSHEAD
FACILITY NUMBER: 197610497
VISIT DATE: 02/11/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff are not reporting incidents

It was alleged that on 01/30/2026, C1 was transported/seen at the Emergency Room (ER) and neither external nor internal Incident Reports were managed by anyone. To investigate this allegation, LPA conducted an interview with the Director of Hospitality and a Therapist, and both parties interviewed informed LPA at the facility expects staff to report incidents to management and from there, a written incident report must be completed and reported to licensing. LPA reviewed all incident reports on a system and did not observe any incidents being submitted to the Community Care Licensing Department (CCLD) since 01/01/2026 to present. LPA contacted facility’s Compliance Services Manager, who confirmed that no incident was submitted to the Regional Office (RO) and informed LPA that they began working at this facility as of 01/23/2026 and since the incident occurred within the first week of their employment, they “missed that part” and failed to submit the written report. Although all four (4) clients interviewed expressed no concerns regarding this allegation, the facility failed to ensure that a written incident report was completed and properly maintained for C1’s ER visit on 01/30/2026.

Deficiency issued on LIC9099-D.
Exit interview conducted, appeal rights explained and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20260209111014
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: AMEND TREATMENT - PORTSHEAD
FACILITY NUMBER: 197610497
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/18/2026
Section Cited
CCR
81061(b)
1
2
3
4
5
6
7
Reporting Requirements: (b) Upon the occurrence, of any of the events... a report shall be made... within the next working day... In addition, a written report shall be submitted to the licensing agency within 7-days following the occurrence of such event.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will provide in-service training to all staff regarding this Section. Also, complete an incident report (RE: 01/30/26) and submit all required documents to LPA by POC date.
8
9
10
11
12
13
14
Based on interviews and record reviews, the licensee did not comply with the section cited above by failing to notify CCLD regarding the incident that occured om 01/30/26, which posed/poses a potential health and safety risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3