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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405800830
Report Date: 01/30/2024
Date Signed: 01/30/2024 12:10:49 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
09/06/2023 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20230906160721
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: 36DATE:
01/30/2024
UNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Licensee/Administrator, Lixia Zhang,TIME COMPLETED:
11:19 AM
ALLEGATION(S):
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Staff did not ensure firearms were properly stored.

INVESTIGATION FINDINGS:
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 At 9:00PM on 01/30/2024, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to continue the investigation to the allegation to this complaint and issue final findings. LPA met with Licensee/Administrator, Lixia Zhang, announced who he is and the reason for the visit. LPA collected documentation and issued final findings to the allegation to this complaint.
As to the allegation of, “Staff did not ensure firearms were properly stored” It was alleged that in approximately in the month of August of 2023, a client 1 (C1) observed staff 1 (S1) with firearm. It was discovered through LPA Jeffries interview on 01/26/2024 of S1, that S1 has never owned a firearm and has never had a firearm in their possession. S1 denied ever having a firearm in the apprtment next to the facility. S1 stated that during the month of August, S1 had been gardening in the area behind the apartment (where C1 had allegedly observed C1 with the firearm). S1 owns the apartment next to the facility, where storing of firearms is not regulated by Community Care Licensing Department (CCLD). On 01/26/2024, LPA Jeffries interviewed C1, initially C1 stated that they didn’t remember, then recanted and stated that they observed S1 holding the “9mm” upside-down. CONTINUED on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
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-20230906160721
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: 01/30/2024
NARRATIVE
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 C1 stated that it was a long time ago but remembers making the same observations a few months prior to this observation. C1 stated that they did not call the local police. On 01/26/2024, LPA interviewed C2, C3, C4, S2, and S3 all denied ever observing any person having a firearm on or around the facility including the back of the apartment. LPA noted that the location of the alleged C1 observation of the S1 being observed with the firearm was not part of the property of the licensed facility and therefore is not enforceable by Title 22 regulations, and there was no police report made on this allegation or the similar prior allegation. At this time there is not enough evidence to support the allegation of, “Staff did not ensure firearms were properly stored.” and is unsubstantiated at this time.

Exit interview, report read, and report provided.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2