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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405800830
Report Date: 03/19/2026
Date Signed: 03/19/2026 12:16:22 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
03/12/2026 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20260312120121
FACILITY NAME:AMERICAN CARE HOMEFACILITY NUMBER:
405800830
ADMINISTRATOR:LIXIA ZHANGFACILITY TYPE:
735
ADDRESS:1240 EL CAMINO REALTELEPHONE:
(805) 466-9029
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:38CENSUS: DATE:
03/19/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria Lopez, Back up to AdministratorTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff verbally assaulted 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 and explained the purpose of the visit.

LPA requested the following records: Staff Roster with telephone numbers, Resident Roster, Staff Schedule for March 2026, Any internal investigation and or staff disciplinary records for incidents involving residents, face sheets for residents interviews. Records were provided to LPA except no current investigation or staff disciplinary records on file for 2025-2026 regarding residents in care.

LPA interviewed Residents at 10:00am, 10:12am, 10:30am, 10:40am, 10:50am, and 11:00am. LPA interviewed Staff at 11:15am, 11:22am, 11:29am, and 11:40am.

On the allegation: Staff verbally assaulted resident. LPA interviewed residents which revealed 6 out of 6 residents stated the staff is not verbally assaultive or abusive to them, Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026
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 29-AS-20260312120121
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: 03/19/2026
NARRATIVE
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and have not heard or seen staff be verbally assaultive to other residents in care, the residents feel safe living in the facility and staff are helpful, residents get three meals per day and the food is good, Residents get into arguments with other residents sometimes but usually about TV time and what is being watched or taking turns, and over all it is a good place to live.

LPA interviewed staff which revealed 4 out of 4 staff on duty said they do not verbally assault residents in care and they have never seen any staff yell, scream or cuss at any residents in care, the residents at times cuss out the staff, Back up Administrator stated many residents with mental health diagnosis and most residents are taking psychotropic medications at the facility, staff report incidents to Administrator and Administrator does submit incident reports to Licensing, Ombudsman office, local Law enforcement, Adult Protective Services and County Mental Health services. Based on the lack of evidence this allegation is Unsubstantiated at this time.

Exit interview conducted, no deficiency cited, copy of report printed for back up Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2