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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405800830
Report Date: 04/01/2026
Date Signed: 04/01/2026 12:06:00 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
03/27/2026 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20260327002222
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:
04/01/2026
UNANNOUNCEDTIME BEGAN:
11:04 AM
MET WITH:Maria Lopez, Office ManagerTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff sprayed a chemical towards a resident 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 10-day complaint visit to the facility above. LPA met with Maria Lopez Office Manager back up to Administrator and explained the purpose of the visit.

LPA requested the following records:
Staff Roster with telephone numbers, resident roster and staff weekly schedule March-April 2026.

LPA interviewed staff at 11:13am. LPA interviewed Residents at 11:08am and 11:29am. LPA interviewed R1's responsible party (RP) at 11:25am.

On the allegation: Staff sprayed a cemical towards a resident in care. LPA interviewed staff which revealed staff clean the tables outside multiple times per day with a spray disifectant cleaner,
Continued 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2026
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-20260327002222
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: 04/01/2026
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
and if the staff gets to a table that has residents sitting at it, the staff will not do that table until all others are done and if the residents are still sitting at the table the staff will ask the residents to move to a cleaned table so the staff can finish cleaning the rest of the tables. The residents have tables all along the back of the facility to sit at to eat, to have conversations, to smoke cigarettes and to just sit outside during the day.
LPA interviewed resident 2 (R2) that stated the staff sprayed the table that resident 1 (R1) was sitting at then sprayed the chemical towards R1. LPA interviewed R1 and R1 said nothing like that ever happened, the staff did not spray at him or at a table R1 was sitting at. R1 has no issues with staffing at the facility.
LPA interviewed R2's responsible party (RP) which revealed R2 is very delusional and it has been worse lately with a medication change, RP and staff are working on this with R2's doctor and hoping to get R2 back on the prior medication, otherwise RP said this will continue to happen due to R2 being very delusional. R2 has a diagnosis of Paranoid Schizophrenia. Based on evidence this allegation is deemed Unsubstantiated at this time.

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

DATE: 04/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2