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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610497
Report Date: 04/28/2026
Date Signed: 04/29/2026 07:28:15 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
02/12/2026 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20260212112659
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: 6DATE:
04/28/2026
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Megan Wu, Program Director TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff do not provide client's medication as prescribed
INVESTIGATION FINDINGS:
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At 10:00am, Licensing Program Analyst (LPA), Angela Panushkina conducted a subsequent visit to deliver final findings. LPA met with the Program Director and explained the reason for the visit.

An initial visit was conducted on 02/19/2026, and at that time LPA requested client and staff roster. At 10:10am, requested copies of pertinent information which include, but not limited to Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, Centrally Stored Medication and Destruction Record (CSMDR), Medication Policy, Staff Training, relevant to the investigation. Between 10:30am - 02:00pm, LPA conducted an interview with the Program Director, Therapist, Clinical Assistant and five (5) clients.

During today's visit LPA obtained current client and staff roster.

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

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
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 5
Control Number 31-AS-20260212112659
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: 04/28/2026
NARRATIVE
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Allegation: Staff do not provide client's medication as prescribed

It was alleged that C1’s medication was discontinued without the facility initiating the prescribed alternative medication. During the initial visit, LPA conducted review of Centrally Stored Medication and Destruction Record (CSMDR) and observed that on 01/30/2026 C1 was prescribed two antidepressant medications

1st – 20MG (1tab x daily) and 2nd - 5MG (1tab x daily) to be taken at the same time. However, review of the facility Medication Administration Records (MAR) revealed that on 01/31/2026, C1 was given 20MG x ½tab; from 02/01/26 to 02/02/26, C1 was given 20MG x 1tab: from 02/03/26 to 02/09/26, C1 was given 20MG x ½tab and from 02/10/26 to 02/16/26, C1 was given 5MG x 1tab. LPA was not provided with physician orders to discontinue one of the medications and/or any recent medication changes for C1. Therefore, based on LPA observation and document review this allegation is Substantiated.

The following deficiency cited 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: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20260212112659
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: 04/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/30/2026
Section Cited
CCR
81075(b)
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Health Related Services: (b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.
This requirement is not met as evidenced by:
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Licensee/Administrator agreed to schedule vendorized training for all staff by 04/25/26 and submit to CCL the vendor information and scheduled date of training. Training certifications to be submitted to CCL upon completion
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Based on interviews and record reviews conducted, licensee did not comply with the section cited above by failing to provide C1's medications as prescribed, which posed an immediate health and safety 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.
SUPERVISOR'S NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
02/12/2026 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20260212112659

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: DATE:
04/28/2026
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Megan Wu, Program Director TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not address client's mental health needs
INVESTIGATION FINDINGS:
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This is an Amendment issued from the original 04/28/2026 report to correct a typographic error on form LIC9099-C

At 2:30pm, Licensing Program Analyst (LPA), Angela Panushkina conducted a subsequent visit to deliver final findings. LPA met with the Program Director and explained the reason for the visit.

An initial visit was conducted on 02/19/2026, and at that time LPA requested client and staff roster. At 10:10am, requested copies of pertinent information which include, but not limited to Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, Centrally Stored Medication and Destruction Record (CSMDR), Medication Policy, Staff Training, relevant to the investigation. Between 10:30am - 02:00pm, LPA conducted an interview with the Program Director, Therapist, Clinical Assistant and five (5) clients.

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

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20260212112659
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: 04/28/2026
NARRATIVE
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Allegation: Staff did not address client's mental health needs

It was alleged that on 02/11/2026, C1 disclosed suicidal thoughts to S1, but the concerns were reportedly dismissed; staff only provided medication and told C1 to go to bed. To investigate this allegation, LPA conducted an interview with the Program Director and was informed that he was hired as of 02/16/2026 and is still in the process of being oriented and brought up to date regarding the clients' needs. LPA conducted an interview with S1 who denied the above allegation and confirmed that C1 was not feeling well, however, C1 never expressed any suicidal thoughts to S1. LPA was also informed that throughout the entire night shift S1 periodically (every 15 minutes) checked on C1 and did not observe alarming behavior. Interview with the Therapist revealed that on 02/12/26 at 9:30am, they met with C1 and C1 informed the Therapist that due to recent medication changes, C1 was not feeling well and complained of having migraine. LPA was also informed that C1 did not report to the Therapist, at that time, that they had suicidal thoughts the night before. However, around 10:13am, the Therapist followed up with C1 to assess safety and C1 reported passive suicidal ideation. Brief Columbia Assessment Tool (BCAT) was given to C1 and based on the answers provided, it was determined that C1 is at “low risk” level and the facility placed the client on 1:1 supervision for 24-hours. Three (3) out of five (5) clients did not report unmet mental health needs during the interview, or statements were inconsistent with the allegation. Interviews did not corroborate that staff failed to address mental health needs. No evidence was obtained indicating neglect or lack of staff response regarding mental health services. Lastly, records review showed documentation of staff efforts to follow up on the client’s mental health concerns, including communication with the mental health professionals when appropriate. Therefore, based on interviews and record reviews, this allegation is deemed Unsubstantiated, at this time.

No deficiency issued.
Exit interview conducted and copy of this report signed and delivered.

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

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5