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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610541
Report Date: 09/02/2025
Date Signed: 09/02/2025 02:08:04 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
08/27/2025 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20250827170110
FACILITY NAME:GODSON HOMEFACILITY NUMBER:
197610541
ADMINISTRATOR:AMIZE, GIBSON EJIKEFACILITY TYPE:
735
ADDRESS:13637 DRONFIELD AVENUETELEPHONE:
(818) 833-7419
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:4CENSUS: 4DATE:
09/02/2025
UNANNOUNCEDTIME BEGAN:
09:42 AM
MET WITH:Gibson Amize - Administrator TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not maintain a comfortable temperature in the home
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with Administrator Gibson Amize and explained the reason for the visit.

LPA conducted a physical plant tour at 10:02 AM, requested copies of facility documents relevant to the investigation at 10:23 AM, reviewed records between 10:30 AM to 11:30 AM and interviewed staff and residents between 11:30 AM to 1:00 PM. Regarding the allegation Staff did not maintain a comfortable temperature in the home, LPA observation during physical plant tour revealed that the thermometer on the wall was set at 81.0°F. The temperature inside during visit was measured 79.3°F in the living room and 81.1°F at the farthest rooms from the main entrance door and/or the living room, all are within the required range. LPA's interview with the only client who is in the facility whose room was also at the far end, revealed that the temperature in his room was fine and was not hot at all. (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025
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-20250827170110
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: GODSON HOME
FACILITY NUMBER: 197610541
VISIT DATE: 09/02/2025
NARRATIVE
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(continued from LIC 9099)

Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3