405800830-1-29-2026-29-AS-KBUY-DQTLWA-20260130080650

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405800830
Report Date: 01/29/2026
Date Signed: 01/29/2026 12:12:18 PM

Unsubstantiated

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
01/23/2026 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20260123122845

FACILITY NAME:	AMERICAN CARE HOME		FACILITY NUMBER:	405800830
ADMINISTRATOR:	LIXIA ZHANG		FACILITY TYPE:	735
ADDRESS:	1240 EL CAMINO REAL		TELEPHONE:	(805) 466-9029
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY:	38	CENSUS:	DATE:	01/29/2026
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Maria Lopez, Back up to Administrator		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff threatened resident

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 Maria Lopez, Back up to Administrator and explained the purpose of the visit.

LPA requested the following records: Staff roster, Resident Roster, Resident 1 (R1's) LIC 602 Physicians report, Medication list and Admission Agreement.

LPA interviewed staff at 10:15am and residents at 10:24 am, 10:30 am, and 10:47am.

On the allegation: Staff threatened resident. LPA interviewed staff 1 (S1) which revealed S1 and Resident 1 (R1) never had a conversation about immigration, no calls were made by staff to immigration and facility staff would not call immigration for any reason. Staff did not threaten any residents in care. Staff 2 (S2) disclosed seeing R1 on the phone, not sure of the date, and heard the words Mexican and immigration but did not listen to the conversation to know what was being said or who R1 was talking to or referring to.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20260123122845

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: AMERICAN CARE HOME	FACILITY NUMBER: 405800830
	VISIT DATE: 01/29/2026

NARRATIVE

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LPA interviewed R1, R1 said R1 does not feel threaten by staff and R1 does feel safe living at the facility. R1 stated R1 heard S1 on the phone and was talking about the military and R1 got upset because R1 was military and did not agree with S1's conversation. R1 does not know who S1 was talking to or what S1 was talking about, only heard S1 say things R1 didn't agree with, and was not sure who S1 was talking about. R1 does not want to get the 5th degree for not agreeing with S1's conversation. R1 said R1 was not sure about staff calling immigration and S1 never said anything directly to R1 about immigration or calling immigration. R1 said he did not see any immigration workers at the facility. R1 heard something about the military and R1 did not like the conversation R1 overheard. Residents interviews revealed staff are good, staff do not threaten residents, never heard staff threaten any other residents, never heard about staff calling immigration, immigrations has not come to the facility when residents have been there. LPA reviewed R1's records at the facility and R1 has a diagnosis of Paranoid Schizophrenia. Based on interviews and record review this allegation is Unsubstantiated at this time.

Exit interview conducted and copy of report printed for Back up Administrator.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026

LIC9099 (FAS) - (06/04)

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