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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405800830
Report Date: 06/10/2026
Date Signed: 06/10/2026 01:50:14 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
06/04/2026 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20260604085756
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:
06/10/2026
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Maria Lopez, Back up AdministratorTIME COMPLETED:
01:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident was assaulted due to staff neglect
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 back up to Administrator and explained the purpose of the visit.

LPA requested a staff and resident roster. LPA interviewed resident 11:04am and Administrator at 11:15am.

On the allegation: Resident was assaulted due to staff neglect. LPA interviewed resident which revealed the resident does not want to make a complaint, the resident was not assaulted at the facility by anyone, and resident does not recall the staff being neglectful in anyway. Administrator stated resident went on vacation with the residents family on a cruise, the residents family mixed up the days of the cruise and did not get resident back for doctor appointments and ran out of residents medications while on vacation.
Continued 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2026
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-20260604085756
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: 06/10/2026
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
Administrator stated the resident is in need of medication injections from residents doctor and is on daily medications to manage paranoia schizophrenia, resident did not return in time so a new appointment was made for May 26th to get residents injection as soon as returning from vacation and started the daily medications. Administrator stated resident did not make any complaints to administrator or staff about any incidents since returning from vacation. Administrator stated the first week resident was back it took time to get the daily benefits of the residents medications back to baseline and the resident is doing fine and has no current medical or mental health issues. Based on the evidence this allegation is deemed 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: 06/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2