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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 421702445
Report Date: 10/17/2024
Date Signed: 10/17/2024 03:49:18 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
07/25/2024 and conducted by Evaluator Erika Miller
COMPLAINT CONTROL NUMBER: 29-AS-20240725122815
FACILITY NAME:SAN ANTONIO RESIDENCEFACILITY NUMBER:
421702445
ADMINISTRATOR:SAN ANTONIO, HELEN SFACILITY TYPE:
735
ADDRESS:620 WEST POLK STREETTELEPHONE:
(805) 928-4989
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:6CENSUS: 5DATE:
10/17/2024
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Norman Almirol, Staff in ChargeTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff roughly handled client in care
Staff hit client in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marc Jeffries (Jeffries) and Tri-Counties Regional Center (TCRC) Quality Assurance Specialist (QA) Vincent Figueroa, (Figueroa) conducted an unannounced initial complaint visit to the facility above on 8/1/24. LPA Jefferies and QA Figueroa met with Jonelyn San Antonio, acting Administrator. LPA Jeffries and QA Figueroa interview staff and residents. LPA Jeffries toured the inside and outside of the facility. LPA Jeffries discovered separated issues that were addressed in a Case Management visit.

On 10/17/24 Licensing Program Analyst (LPA), Erika Miller (Miller), met with Norman Almirol, Staff and issued final findings on the allegations above. LPA Miller reviewed relevant documentation and took a cursory tour of facility.

(Continnued on 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Erika Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
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-20240725122815
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: SAN ANTONIO RESIDENCE
FACILITY NUMBER: 421702445
VISIT DATE: 10/17/2024
NARRATIVE
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Allegation: Staff handled resident in a rough manner and hit residents
Reporting party (RP) provided second-hand information from a housemate at facility. RP claims that housemate claims to have heard a slap and then Resident 1 (R1) exclaim that Staff 1 (S1), hit him. On another occasion, the housemate heard R1 exclaim to S1 “You have to be gentle with me.” RP further stated that another housemate alleged that S1 sat on R1’s legs.

Based on multiple interviews there is not sufficient evidence to support that R1 was handled in a rough manner or that staff hit residents. Residents stated that R1 likes S1. Residents did not observe or hear R1 being handled in a rough manner or cry out in pain. R1 stated that they feel safe in the home and with S1. R1 denied that they were sprayed in the face with water. R1 confirmed that S1 sat on their legs, but that it did not hurt.

Although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

An Exit interview conducted, and a copy of this report issued.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Erika Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2