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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405809547
Report Date: 02/26/2026
Date Signed: 02/26/2026 02:42:55 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
07/11/2025 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 29-AS-20250711112047
FACILITY NAME:OAKS AT NIPOMO, THEFACILITY NUMBER:
405809547
ADMINISTRATOR:RONALD C. FREEMANFACILITY TYPE:
740
ADDRESS:177 MARY AVENUETELEPHONE:
(805) 723-5206
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY:122CENSUS: 96DATE:
02/26/2026
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Ron FreemanTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff are not following mandated reporter requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to issue final findings on this investigation. LPA met with Ron Freeman and explained the purpose of the visit. During the investigation, LPA conducted an initial visit on 07/16/2025 where LPA conducted interviews with residents and staff from 11:25am to 3:15pm, and obtained relevant documents. LPA conducted additional interviews with staff on 10/01/2025; with residents on 11/21/2025; and with a witness on 1/16/2026. A review of prior complaint # 29-AS-20250130150442 was completed. The prior complaint involved the eviction of Resident 1 (R1). Interviews conducted on 02/6/2025 and 02/27/2025 were used for evidence.

On the allegation: Facility staff are not following mandated reporter requirements. It was alleged the Administrator and staff failed to report alleged abuse of their residents, violating their legal mandate to do so. The reporting party stated an eviction notice was issued to R1. Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026
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 5
Control Number 29-AS-20250711112047
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: OAKS AT NIPOMO, THE
FACILITY NUMBER: 405809547
VISIT DATE: 02/26/2026
NARRATIVE
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The notice indicated the cause of eviction included behaviors by R1 that constituted “harassment or psychological abuse or causes mental suffering of an elder or dependent adult.” It was alleged if the behaviors rose to the level supporting an eviction notice, then the Administrator and staff, as mandated reporters, should have reported the abuse to Community Care Licensing (CCL), the local Long Term Care Ombudsman (LTCO) program, and local law enforcement using the SOC341 forms.

Interviews conducted with residents indicated that R1 discouraged them from sitting with preferred companions, interfered with group participation, and was observed repeatedly raising their voice and talking rudely to staff. Two residents stated R1 repeatedly entered another resident’s apartment uninvited to complain, as this resident was the resident council president, but was on Hospice. Multiple residents reported avoiding dining and activities due to R1, some observed other residents crying after interactions with R1, and two residents stated they would move out if R1 remained.

Resident Services Coordinator stated during interview R1 was overheard calling residents “dumb” or “not smart,” told some “you don’t belong,” and created a hostile environment. Staff interviewed stated they observed R1 yelling at residents and staff. On one occasion Staff 8 (S8) witnessed R1 throw a purse at a resident over a seating dispute on the bus. Staff noted residents with mild cognitive impairment were targeted and staff claim that some residents feared retaliation if they reported an incident and R1 found out about the report.

LPA obtained facility forms titled “Resident/Family Grievance report”. Twenty-two (22) forms were collected, all regarding R1. Eleven (11) of the twenty-two (22) forms document events between 07/03/2024 and 03/09/2025 of R1 refusing seating or activity participation to other residents, repeated unwanted phone calls to Resident 10 (R10), loud/banging noises affecting neighboring residents, demeaning comments to staff, misuse of laundry machines causing disruption in other residents using them, and multiple resident/staff grievances.

LPA received an Incident Report from 11/23/2024. The incident report documented a resident reporting to the facility that they were being harassed by R1, R1 was calling their cell phone repeatedly, and resident reported they felt very uncomfortable around R1 because they feel pressured or manipulated to join activities and meals. Continued on 9099-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20250711112047
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: OAKS AT NIPOMO, THE
FACILITY NUMBER: 405809547
VISIT DATE: 02/26/2026
NARRATIVE
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A letter dated 12/05/2024 was sent to LPA Rankin documenting instances of R1’s insulting and rude behavior to other residents causing them distress, rejecting residents from playing games, persistent unwanted phone calls to residents, loud noises in R1’s apartment, and screaming at staff.

Additional documents collected include letter correspondence and an eviction notice for R1. A letter from 11/15/2024 documented verbal harassment of staff, screaming and insults; R1 was reminded harassment violates resident handbook. A letter from 11/28/2024 documented other residents feeling harassed, receiving unwanted attention, and feeling targeted; R1 was instructed harassment must cease and was warned against retaliation. A letter from 12/11/2024 documented turning away a resident from seating, rude conduct, persistent complaints; it was reiterated to R1 harassment was prohibited. A letter from 01/02/2025 noted harassment toward servers. R1’s eviction notice includes summaries of fifteen (15) instances where R1 verbally berated, yelled, and pressured or mistreated staff; and four (4) instances involving R1’s treatment of residents, which were corroborated by the interviews and grievance reports. Although a majority of the reported mistreatment was directed toward staff, residents were also present for some of these incidents and observed these interactions, which, according to interviews and grievances, created an environment of fear and psychological distress for residents, and disrupted their sense of safety and well-being.

California Code of Regulations Title 22 87211(a)(1)(D) states the licensee must submit a written reporting to CCL within seven (7) days of “Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident.” Mandated reporters must report abuse using form SOC341 per the definitions in Welfare and Institutions Code (WIC) §15610.07(a)(1) [“Abuse of an elder or a dependent adult” means any of the following: Physical abuse, neglect, abandonment, isolation, abduction, or other treatment with resulting…mental suffering.”] and WIC §15610.53 [“Mental suffering" means fear, agitation, confusion, severe depression, or other forms of serious emotional distress that is brought about by forms of intimidating behavior, threats, harassment, or by deceptive acts performed or false or misleading statements made with malicious intent to agitate, confuse, frighten, or cause severe depression or serious emotional distress of the elder or dependent adult.”]
Continued on 9099-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20250711112047
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: OAKS AT NIPOMO, THE
FACILITY NUMBER: 405809547
VISIT DATE: 02/26/2026
NARRATIVE
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The evidence shows that R1’s behaviors constitute incident(s) that threaten the welfare and safety of residents and aligns with the definition of treatment resulting in mental suffering. The evidence demonstrates a pattern of psychological harassment by R1 toward staff and other residents, which negatively impacted the facility environment. Despite being aware of these effects, neither the Administrator nor staff submitted SOC341 reports to CCL, nor to LTCO or law enforcement as required per Welfare and Institutions Code (WIC) 15630.

Based on interviews and documentation, there is a preponderance of evidence that the facility failed to meet mandated reporting requirements regarding suspected psychological abuse/mental suffering. Therefore, the allegation is substantiated at this time. This case will be cross-reported to California Department of Justice/Division of Medi-Cal Fraud and Elder Abuse (DOJ/DMFEA) and local law enforcement for failure to follow mandated reporter requirements.

An exit interview was conducted, deficiency cited on 9099-D, a copy of this report and the appeal rights was provided.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20250711112047
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: OAKS AT NIPOMO, THE
FACILITY NUMBER: 405809547
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/26/2026
Section Cited
CCR
87211(a)(1)(D)
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87211(a)(1)(D)
Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:…Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents…
This requirement is not met as evidenced by:
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The Administrator agrees to ensure that all facility staff receive comprehensive training on Mandated Reporting. The training will include topics related to harassing behaviors, psychological abuse, isolation, and contributing factors such as resident-on-resident abusive interactions.
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Based on interview and record review, the licensee did not comply with the section cited when the Administrator/staff did not submit an SOC341 for abuse by R1, which posed a potential health, safety, and personal rights risk to residents in care.
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The training will emphasize staff responsibilities in recognizing, preventing, documenting, and reporting all forms of abuse in accordance with Title 22 regulations and Health & Safety Code requirements. Documentation of completed training, including sign-in sheets and training materials, will be maintained at the facility and submitted to CCL by 3/26/26.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5