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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 421703604
Report Date: 09/08/2025
Date Signed: 09/08/2025 09:45:46 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/04/2025 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20250904155314
FACILITY NAME:ORCUTT BOARD AND CARE HOMEFACILITY NUMBER:
421703604
ADMINISTRATOR:ANNIE YAGUEFACILITY TYPE:
740
ADDRESS:263 CRESCENT AVE.TELEPHONE:
(805) 934-2586
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:6CENSUS: 2DATE:
09/08/2025
UNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Administrator, Annie YagueTIME COMPLETED:
09:50 AM
ALLEGATION(S):
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Facility is violating residents personal rights by locking them in their bedroom at night.
INVESTIGATION FINDINGS:
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 At 7:30am on 09/08/2025, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the initial investigation to the allegation to this complaint. LPA met with Licensee/Administrator Annie Yague, announced who he is and the reason for the visit. LPA conducted a physical tour of the facility and interview with Licensee/Administrator and was able to determine final findings during this investigation visit.
As to the allegation of, "Facility is violating resident personal rights by locking them in their bedroom at night." It was alleged that, facility is locking residents in their bedrooms at night. On 09/08/2025 LPA Jeffries arrived to the facility at 7:45am to discover Resident 2 (R2) in bedroom 2 with a screw lock door that was locked. Administrator used a dime to unlock bedroom 2 door, LPA observed R2 still in bed behind locked door. LPA observed screw lock doors on all resident bedrooms. On 09/08/2025, LPA conducted interview with Licensee/Administrator Annie Yague, who stated, "I know why your here, we just lock the doors so that (R1) doesn't go in other residents rooms." On 09/05/2025, LPA interviewed Family Member 1 (F1) who stated that R1 left facility due to being locked in the room during the night and morning.
CONTINUED on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
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 3
Control Number 29-AS-20250904155314
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ORCUTT BOARD AND CARE HOME
FACILITY NUMBER: 421703604
VISIT DATE: 09/08/2025
NARRATIVE
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Based on interviews, admission, and observation there is evidence to support the allegation of, "Facility is violating residents personal rights by locking residents in their bedroom at night." and is substantiated at this time.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20250904155314
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: ORCUTT BOARD AND CARE HOME
FACILITY NUMBER: 421703604
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/09/2025
Section Cited
CCR
87468.1
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87468.1 Personal Rights of Residents in All Facilities (a) Residents ...shall have the following personal rights:(6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This does not prohibit a licensee from establishing house
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Administrator agrees to change the door knobs on all resident rooms to door knobs without locks that lock from the outside. Administrator also agrees to have all staff participate in 1 hour of personal rights training by an CCLD authorized vendor. Administrator will provided proof to LPA
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rules, such as locking doors at night to protect residents, ..., with permission from the Department. This requirement was not met by evidence of admission and observation of resident rooms being locked in bedrooms which poses an imminent danger to residents in care.
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of class chosen by email no later than 09/09/2025, and have all training done as soon as possible.
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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: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3