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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 421702445
Report Date: 10/14/2025
Date Signed: 10/14/2025 03:23:30 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
10/06/2025 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 29-AS-20251006081316
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: 4DATE:
10/14/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Arthur San AntonioTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff violated resident's personal rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rankin and Tri Counties Regional Center (TCRC) Quality Assurance Specialist Wesley Marking (QAS) conducted a subsequent complaint visit to issue final findings on this investigation. LPA met with Arthur San Antonio and explained the purpose of the visit. During the investigation, LPA and QAS conducted an initial visit on 10/8/25, where LPA and QAS conducted interviews with administrator, client, and 2 staff, also obtained relevant documents. Return visit on 10/14/25, LPA and QAS interviewed 2 clients.

On the allegation: Staff violated resident's personal rights
It was alleged that an overnight caregiver had pushed Client 1 (C1) and had been verbally abusing C1 and stealing their belongings. Continued - 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
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 2
Control Number 29-AS-20251006081316
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: 10/14/2025
NARRATIVE
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Documents provided to Licensing and TCRC also allege the client was pushed while in the shower.

When interviewed, C1 did not report being pushed in the shower or having any items stolen. C1 expressed concern that Staff (S1) may have used a personal item (phone cord) without permission. Regarding verbal abuse, the only statement C1 recalled was S1 allegedly saying, “go ahead and hit me” and C1 alleges S1 indicated for C1 to hit them on their cheek. C1 confirmed they were not injured but did mention being pushed onto a bed at one point. C1 also stated that S1 did not assist with showering.

During interviews conducted on 10/8/25 and 10/14/25, witnesses reported that they did not observe any incidents of theft, verbal abuse, or physical abuse involving S1. Witnesses stated that S1 arrived for their shift, followed instructions provided by outgoing staff, and performed their duties as expected. Staff stated that S1 did help C1 with showering. Interview with clients on 10/14/2025 clients described S1’s personality, but did not provide more evidence to prove that S1 was verbally or physically abusive to C1.

Based on the interviews conducted, there is insufficient evidence to substantiate the allegations of theft, verbal abuse, or physical abuse. The facility acted promptly by removing S1 from duty upon learning of the allegations. C1 confirmed they are currently well and feel supported by the staff presently assisting them. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted. Copy of report given to administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2