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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610670
Report Date: 02/04/2025
Date Signed: 02/04/2025 11:37:30 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
01/31/2025 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20250131114613
FACILITY NAME:TIGERTAIL ADULT HOME 3, INC.FACILITY NUMBER:
197610670
ADMINISTRATOR:WAULS, ASILIAFACILITY TYPE:
735
ADDRESS:4303 OLIVERA PLACETELEPHONE:
(661) 433-0625
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:4CENSUS: 4DATE:
02/04/2025
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Jamelene EnolaTIME COMPLETED:
11:47 PM
ALLEGATION(S):
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Staff are mistreating residents while in care.
INVESTIGATION FINDINGS:
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On 02/04/2025 at 9:35 a.m., Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced complaint visit in response to the above mentioned allegation. LPA was granted entry into the facility by staff. Present at the facility upon arrival were three (3) out of ten (10) staff and two (2) out four (4) clients. Staff contacted the Licensee, Asilia Wauls and house manager Jamelene Enola. LPA met with the house manager at 9:55 a.m., and explained the reason for the visit. Entrance interview conducted.

At around 9:40 a.m., LPA conducted a physical plant inspection to ensure the health and safety of the clients in care. No issues or concerns were observed. On today's visit from approximately 9:51 a.m. to 10:45 a.m., LPA conducted interviews with client #1(C1) and attempted to interview client #2 (C2). C2 did not respond to LPA's questions. LPA also interviewed four (4) staff and the Licensee. LPA reviewed and obtained the facility's Personnel Record (LIC500), employee roster from Guardian Background Check System and client roster. (Continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
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 2
Control Number 31-AS-20250131114613
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: TIGERTAIL ADULT HOME 3, INC.
FACILITY NUMBER: 197610670
VISIT DATE: 02/04/2025
NARRATIVE
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(Continued from LIC9099) Allegation: Staff are mistreating residents while in care. It is alleged staff #1(S1) and staff#2 (S2) have restrained, spanked, hit residents on the chest, and spoken inappropriately to clients for whom they provide one to one care. LPA's interview with C1 revealed that no individuals by the names provided in the allegation have worked at the facility during C1's stay. Interviews with four (4) staff corroborate that no staff members by the names provided in the allegation provide care at this facility and that they have not witnessed mistreatment of clients. C1 also denied being mistreated by any staff as described in the allegation. Additionally, LPA's review of the LIC500 revealed that the names of the staff in the allegation are not listed. However, a review of the employee roster from the Guardian Background Check System does show S1 and S2 associated with this facility. The Licensee and the house manager explained in their interviews, not verbatim, that it is common practice to associate staff across different facilities to ensure coverage when needed. In their interviews, both the house manager and the Licensee denied that S1 and S2 have ever provided care and supervision to the clients at this facility. Based on interviews and record review, this allegation is deemed Unsubstantiated.

No deficiency cited. Exit interview conducted. Copy of this report provided.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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