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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405850094
Report Date: 07/16/2025
Date Signed: 07/16/2025 05:16:27 PM

Unsubstantiated


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
06/23/2025 and conducted by Evaluator Garrett Haner-Tomasko
COMPLAINT CONTROL NUMBER: 29-AS-20250623084614
FACILITY NAME:ANGEL'S GROUP HOMEFACILITY NUMBER:
405850094
ADMINISTRATOR:CHONG KIMFACILITY TYPE:
735
ADDRESS:2648 VINEYARD CIRCLETELEPHONE:
(805) 369-2394
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:4CENSUS: 4DATE:
07/16/2025
UNANNOUNCEDTIME BEGAN:
02:59 PM
MET WITH:Backup Administrator - Ivan PalominosTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff are not meeting resident's grooming needs.
Staff did not provide resident with weather appropriate clothing and shoes.
Staff did not safeguard resident's personal belongings.
Staff are not meeting resident's hygiene needs.
Staff are not meeting resident's toileting needs.
INVESTIGATION FINDINGS:
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On 07/16/2025 at 3:00pm Licensing Program Analyst (LPA) Haner-Tomasko arrived unannounced at the facility to deliver final findings regarding the allegations to this complaint and conduct a case management visit. LPA met with Backup Administrator Ivan Palominos and explained the purpose of the visit.

During the visit from 3:05pm to 3:30pm, LPA conducted additional client and staff interviews.

On the allegations: Staff are not meeting resident's grooming needs. It was alleged Client #1 (C1) was limping due to having extremely long toenails that had not been cut in nine months. LPA interviews and review of C1’s records revealed C1 moved to the facility in October 2024 and in January 2025 C1 was seen by a podiatrist for a foot exam and had their nails debrided to hygienic length.

(Continued LIC809-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2025
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 3
Control Number 29-AS-20250623084614
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: ANGEL'S GROUP HOME
FACILITY NUMBER: 405850094
VISIT DATE: 07/16/2025
NARRATIVE
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The physicians visit summary to this appointment states in the Plan of Care that a routine visit be scheduled on or around 4/28/2025 and the physician summary after C1 visited their primary care physician on 4/23/2025 shows a scheduled appointment with the podiatrist on 4/28/2025 at 9:30am. Staff interviews revealed they were not aware of this appointment and C1 missed the podiatrist appointment on 4/28/2025. LPA addressed the requirement for the facility to follow through with client appointments on a case management report at this same visit. The physician summary notes after C1 visited their primary care physician on 5/9/2025 indicate the next scheduled podiatrist appointment was scheduled for June 2025. LPA interviews revealed that on 6/9/2025 C1’s family took them to a nail salon for a pedicure and in June 2025 the facility transported them to their scheduled podiatrist appointment. Based on all interviews conducted and documents obtained, at this time the above allegation was found to be unsubstantiated, meaning there is not a preponderance of evidence to prove that the alleged violation occurred.

On the allegations: Staff are not meeting resident's hygiene needs and staff are not meeting resident's toileting needs. It was alleged C1 had ‘lacerations’ on their back due to using the doorway as a back scratcher because they were itchy, and C1 had feces on their backside due to facility staff not supporting client. LPA interviews and review of C1’s records revealed in November 2024 the facility arranged for C1 to be seen by their primary care physician at the soonest available appointment in January 2025 for a skin issue causing C1 to be itchy. At the appointment in January 2025 the physician ordered a topical prescription and Staff #1 (S1) stated they assist C1 apply the medication as prescribed to areas C1 cannot reach and C1 stated they receive assistance from staff to apply the medication. S1 stated C1 has never refused the topical medication. C1 has been seen regarding their itchy skin; by an urgent care doctor in April 2025, in the same month (April 2025) they had a follow-up with their primary care physician, another follow-up in May 2025, and again in June 2025. C1 stated they have itchy skin every summer and they feel, as of the LPA visit on 7/2/2025, the issue is improving. LPA record review of C1’s assessment, appraisal and physician report revealed C1 is able to care for their own toileting needs. C1 states they can take care of their own care needs and can ask staff for help if needed. S1 stated C1 refuses help from staff and is private. S1 reminds C1 to be thorough when caring for their personal hygiene. Based on all interviews conducted and documents obtained, at this time the above allegations were found to be unsubstantiated, meaning there is not a preponderance of evidence to prove that the alleged violations occurred.

(Continued on LIC809-C)

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20250623084614
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: ANGEL'S GROUP HOME
FACILITY NUMBER: 405850094
VISIT DATE: 07/16/2025
NARRATIVE
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On the allegations: Staff did not safeguard the residents’ personal belongings and staff did not provide resident with weather appropriate clothing and shoes. It was alleged C1 has one pair of shoes and does not have summer appropriate clothing because staff threw out C1’s belongings. On 7/2/2025, C1 showed LPA all of their belongings, LPA observed and photographed 12 pairs of footwear C1 stated belonged to them; three pairs of slippers, two pairs of boots, and seven pairs of sneakers. C1 stated their shoes fit and do not hurt when wearing them. LPA noted a variety of clothing in C1’s room and closet, appropriate for hot and cool weather. LPA interviews revealed when C1 was residing at another facility that closed, C1 had to move to this facility in a short amount of time. Initially C1 brought enough clothing for a few days and staff from the previous facility brought the rest of their belongings within a few days. LPA interviews revealed the Licensee of this facility worked with C1 to donate some of their clothing to Goodwill. C1 stated they only donated old clothing that was ripped or had holes and that they were not forced to get rid of their belongings. C1 stated no one has ever thrown out their belongings without their permission. C1 stated they have all the clothing and shoes they need. Based on all interviews conducted and documents obtained, at this time the above allegation was found to be unsubstantiated, meaning there is not a preponderance of evidence to prove that the alleged violation occurred.

Exit interview, report signed, and report provided.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3