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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405850222
Report Date: 04/08/2025
Date Signed: 04/08/2025 01:14:00 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
04/04/2025 and conducted by Evaluator Garrett Haner-Tomasko
COMPLAINT CONTROL NUMBER: 29-AS-20250404134901
FACILITY NAME:LIFETOUCH THE ELEGANT LIVING RESIDENTIAL HOME CAREFACILITY NUMBER:
405850222
ADMINISTRATOR:AQUINO, AMELITA I.FACILITY TYPE:
740
ADDRESS:1934 TULIPWOOD DRIVETELEPHONE:
(805) 878-3409
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:6CENSUS: 2DATE:
04/08/2025
UNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Administrator - Amelita AquinoTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Uncleared individual(s) are caring for residents
INVESTIGATION FINDINGS:
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On 04/08/2025 at 08:57am Licensing Program Analyst (LPA) Haner-Tomasko conducted a 10-day complaint visit to the facility above. LPA met with Administrator Amelita Aquino and explained the purpose of the visit.
During the visit, LPA interviewed staff, residents, administrator, and obtained relevant documents.

On the allegation: Uncleared individual(s) are caring for residents. It was alleged the facility has uncleared individuals working and caring for the residents. LPA reviewed 5 of 5 staff fingerprint clearances. LPA noted three individuals in the facility, two were cleared staff. LPA noted the third individual, Person 1 (P1), is not fingerprint cleared and was cooking and cleaning in the facility at the time of the visit. Resident and staff interviews revealed P1 has contact with the residents, resides in the facility part-time, and provides resident assistance in bathing.

(Continued LIC9099-C)
Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
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 5
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
04/04/2025 and conducted by Evaluator Garrett Haner-Tomasko
COMPLAINT CONTROL NUMBER: 29-AS-20250404134901

FACILITY NAME:LIFETOUCH THE ELEGANT LIVING RESIDENTIAL HOME CAREFACILITY NUMBER:
405850222
ADMINISTRATOR:AQUINO, AMELITA I.FACILITY TYPE:
740
ADDRESS:1934 TULIPWOOD DRIVETELEPHONE:
(805) 878-3409
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:6CENSUS: 2DATE:
04/08/2025
UNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Administrator - Amelita AquinoTIME COMPLETED:
01:20 PM
ALLEGATION(S):
1
2
3
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9
Facility staff caring for residents are not physically capable of caring for them.
INVESTIGATION FINDINGS:
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On 04/08/2025 at 08:57am Licensing Program Analyst (LPA) Haner-Tomasko conducted a 10-day complaint visit to the facility above. LPA met with Administrator Amelita Aquino and explained the purpose of the visit. During the visit, LPA interviewed staff, residents, administrator, and obtained relevant documents.

On the allegation: Facility staff caring for residents are not physically capable of caring for them. It was alleged the individuals caring for the residents do not know what they are doing, cannot lift the residents and cannot communicate with the residents. During the visit LPA noted two staff at the facility, Staff 1 (S1) and Staff 2 (S2) are the primary live-in staff. LPA observed the two staff verbally communicating with both residents, in the resident’s native language. LPA observed both staff meeting residents needs. LPA observed both Resident 1 (R1) and Resident 2 (R2) transfer themselves and walk with minimal assist.

(Continued LIC9099-C)
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20250404134901
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: LIFETOUCH THE ELEGANT LIVING RESIDENTIAL HOME CARE
FACILITY NUMBER: 405850222
VISIT DATE: 04/08/2025
NARRATIVE
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Resident and staff interviews and resident record review revealed R1 and R2 do not require transfer or lift assistance. Resident interview revealed staff are meeting their needs. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

Exit interview and report given.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20250404134901
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: LIFETOUCH THE ELEGANT LIVING RESIDENTIAL HOME CARE
FACILITY NUMBER: 405850222
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/09/2025
Section Cited
CCR
87355(e)(2)
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Criminal Record Clearance. All individuals subject to a criminal record review…shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption…This requirement was not met as evidenced by:
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Administrator agrees to not allow P1 back into the facility until they are fingerprint cleared and have P1 fingerprinted by Livescan in the next 24 hours. Administrator will email LPA clearance documentation prior to allowing P1 back in the facility.
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Based on interviews, the licensee did not comply with the section cited above when Administrator allowed a non-cleared person, P1, to have contact with the residents, reside in the facility, and assist resident bathing, which posed an immediate health and safety risk to clients in care.
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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: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20250404134901
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: LIFETOUCH THE ELEGANT LIVING RESIDENTIAL HOME CARE
FACILITY NUMBER: 405850222
VISIT DATE: 04/08/2025
NARRATIVE
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 P1 was able to leave the facility as two cleared staff were present and able to meet the needs of the residents. Based on the information obtained, the allegation is deemed Substantiated at this time.

Exit interview, deficiencies cited on 9099-D, civil penalty issued, report given, and appeal rights given.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5