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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405800061
Report Date: 07/31/2025
Date Signed: 07/31/2025 12:04:42 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
07/22/2025 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20250722125417
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:
07/31/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Joni Chapman, AdministratorTIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Staff do not ensure clients always have access to the home
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) De Leon conducted a 10-day complaint visit to the facility above. LPA met with Joni Chapman, Administrator and LPA explained the purpose of the visit.

On the allegation:Staff do not ensure clients always have access to the home. LPA spoke with the Administrator regarding the incident on 06/11/2025. The Administrator was present at the facility on the day of the incident and had taken a break when the incident occurred. Staff 1 (S1) was doing a medication pass for a resident and was unable to find Staff 2 (S2), S1 felt for the safety of Resident 1 (R1) S1 would lock the front door while R1 was outside in the enclosed front yard, S1 then passed the medications to another resident and S1 unlocked the door. The duration of the door being locked was around five minutes. R1 is to be provided with a 1 on 1 care during the day and on this day the facility staffing was short, and Staff did not provide R1 with 1 on 1 care and support. The incident was reported to the Executive Director on 07/20/2025 by S2.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
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 29-AS-20250722125417
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: 07/31/2025
NARRATIVE
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LPA reviewed R1 records which revealed that R1 is non-verbal, has a diagnosis of PICA and requires care and supervision. R1 was not provided with the care and supervision necessary to meet R1’s needs, R1’s behavior and care plans were not followed and locking R1 out of R1’s home violated R1’s personal rights therefore this allegation is deemed Substantiated at this time.

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

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 29-AS-20250722125417
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/01/2025
Section Cited
CCR
80072(a)(3)
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(a)...(3)To be free from corporal or unusual punishment,...ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to:interference with the daily living functions, including...or withholding of shelter,...This requirement was not met as evidenced by:
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Administrator and all staff working at the facility will retake Personal Rights, Mandated Reporting, Abuse Reporting, Incident Reporting, read all Residents Behavior Plans, Appraisal Needs and Services Plans and TCRC Individual Service Plans, and understand each plan cont below:
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Based on interview and record review the Licensee did not comply with the regulation above R1 was locked outside R1’s home by staff which possesses an immediate health, safety and personal rights risk to residents in care.
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and how to meet R1’s needs appropriately. Provide proof of Training and an up-to-date LIC 500 to CCL.
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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.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3