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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405800061
Report Date: 03/19/2025
Date Signed: 03/19/2025 02:45:43 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. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/13/2024 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20241213095139
FACILITY NAME:C.A.L.L.-SAN ANTONIO HOUSEFACILITY NUMBER:
405800061
ADMINISTRATOR:JONI CHAPMANFACILITY TYPE:
735
ADDRESS:13600 SAN ANTONIOTELEPHONE:
(805) 466-6274
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:6CENSUS: 5DATE:
03/19/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Joni Chapman, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff left resident unattended.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) De Leon conducted a subsequent complaint visit to deliver findings for the above allegation. LPA met with Joni Chapman Administrator and explained the purpose of the visit.

On 12/12/2024, the Department received a complaint regarding Client #1 (C1) sustaining bruising and injuries due to staff neglect and/or abuse, and staff not providing C1 timely medical care. The complaint was referred to the Community Care Licensing Division (CCLD) Investigations Branch (IB) and assigned to Investigator Jorge Jauregui. The Department substantiated both allegations on 03/19/2025.

On 12/13/2024, the Department received a complaint alleging staff did not provide proper care as Client #1 (C1) was left unattended in the facility. The complaint allegation was related to the same incident and allegations previously substantiated in the 12/12/2024 complaint.
Continued 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
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 4
Control Number 29-AS-20241213095139
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: C.A.L.L.-SAN ANTONIO HOUSE
FACILITY NUMBER: 405800061
VISIT DATE: 03/19/2025
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
On 12/20/2024, from 9:30am to 10:15am, Licensing Program Analyst (LPA) Rachael De Leon conducted an initial complaint visit to the facility. LPA De Leon met with Joni Chapman, Administrator and explained the purpose of the visit. The LPA requested records pertinent to the investigation. The LPA advised they would return at a later date to deliver findings.

The Department’s Investigation Report for complaint #29-AS-20241212124657 related to the 12/10/2024 incident included interviews, facility video footage, photos of C1’s injuries, Twin Cities Community Hospital medical records, San Luis Obispo (SLO) Sheriff’s Department Report #2412-09017, and facility file documents related to the investigation.

The Department’s investigation revealed that on 12/10/2024, C1 suffered an anxiety attack while in care at the facility. This resulted in self-inflicted injuries from C1 repeatedly striking their head against hard objects – floor, wall, door frame, chair and bench. C1’s behavioral plan specifies staff should closely monitor C1 if C1 exhibits self-injurious behaviors. During the anxiety attack, staff took C1 to C1’s bedroom where for extended periods, as shown by the facility video footage, C1 was not checked by staff. C1’s bedroom walls are padded but not the floor. It is unknown if C1 continued to bang their head on the bedroom floor and hard objects as there are no cameras in the bedroom. Due to improper staff supervision and monitoring, staff did not notice C1’s facial and head injuries until the morning of 12/11/2024. Therefore, the allegation “Neglect/Lack of Supervision: Staff left resident unattended” is deemed Substantiated at this time.

The licensee was previously cited on 03/19/2025 for the same incident under complaint # 29-AS-20241212124657. Therefore, on this date, no citations or civil penalties will be issued.

Exit interview conducted copy of report and appeal rights printed for Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/13/2024 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20241213095139

FACILITY NAME:C.A.L.L.-SAN ANTONIO HOUSEFACILITY NUMBER:
405800061
ADMINISTRATOR:JONI CHAPMANFACILITY TYPE:
735
ADDRESS:13600 SAN ANTONIOTELEPHONE:
(805) 466-6274
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:6CENSUS: 5DATE:
03/19/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Joni Chapman, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility has inadequate food service for the residents in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) De Leon conducted a subsequent complaint visit to deliver findings for the above allegation. LPA met with Joni Chapman Administrator and explained the reason for the visit.

On 12/12/2024, the Department received a complaint regarding Client #1 (C1) sustaining bruising and injuries due to staff neglect and/or abuse, and staff not providing C1 timely medical care. The complaint was referred to the Community Care Licensing Division (CCLD) Investigations Branch (IB) and assigned to Investigator Jorge Jauregui. The Department substantiated both allegations on 03/19/2025.

On 12/13/2024, the Department received a complaint alleging staff did not provide proper care as Client #1 (C1) was left unattended in the facility and facility has inadequate food service for the residents in care. One of these complaint allegation was related to the same incident and allegations previously substantiated in the 12/12/2024 complaint.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20241213095139
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: C.A.L.L.-SAN ANTONIO HOUSE
FACILITY NUMBER: 405800061
VISIT DATE: 03/19/2025
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
On 12/20/2024, from 9:30am to 10:15am, Licensing Program Analyst (LPA) Rachael De Leon conducted an initial complaint visit to the facility. LPA De Leon met with Joni Chapman, Administrator and explained the purpose of the visit. The LPA requested records pertinent to the investigation and toured facility kitchen food supply and emergency food and water supply. The LPA advised they would return at a later date to deliver findings.

The Department’s Investigation Report for complaint #29-AS-20241212124657 related to the 12/10/2024 incident included interviews, facility video footage, photos of C1’s injuries, Twin Cities Community Hospital medical records, San Luis Obispo (SLO) Sheriff’s Department Report #2412-09017, and facility file documents related to the investigation.

LPA De Leon visited the facility on 12/13/2024, 12/20/2024, 01/29/2025, 02/19/2025 and 03/19/2025
toured facility kitchen and food supply as well as emergency food and water supply at the facility, LPA observed an adequate food supply on each visit. LPA interviewed Tri-Counties Regional Center (TCRC) Quality Assurance (QA) Jeff Edler which revealed the food supply has not been an issue and the food supply has always been adequate for the residents in care on each facility visit. Based on LPA observation and interview the facility food supply is adequate and this complaint is Unsubstantiated at this time.

Exit interview conducted and copy of report printed for Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4