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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 421703748
Report Date: 07/03/2026
Date Signed: 07/03/2026 11:57:14 AM

Unsubstantiated


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
07/02/2026 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20260702133236
FACILITY NAME:PURISIMA HILLSFACILITY NUMBER:
421703748
ADMINISTRATOR:SUSAN MARSHFACILITY TYPE:
740
ADDRESS:237 ALDEBARAN AVENUETELEPHONE:
(805) 733-4395
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:6CENSUS: 4DATE:
07/03/2026
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Susan Marsh, AdministratorTIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Licensee is denying resident access to visitors
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) De Leon conducted a 10-day complaint visit to the facility above. LPA met with staff whom called Administrator Susan Marsh and LPA explained the purpose of the visit. Administrator came shortly after to met with LPA.

LPA De Leon toured Resident 1's (R1) room and spoke with R1. R1 is on Hospice Services with Dignity. LPA took copies of sign in sheet at the facility for visititation of residnets in care. R1 has had visitors on a regular bases. On 07/02/2026 3 vistors came to the facility to see R1, a volunteer, a shower aide and a registered nurse (RN) all from Dignity Hospice. R1 had a prior hospice volunteer that transferred R1 without a care staff and R1 sustained a skin tear and bruise, the facility asked dignity managmeent not to sent the volutneer due to this incidnet and asked for someone else to be sent in place, another volunteer was sent and has visited R1 on 06/29/2026 and 07/03/2026, the volunteer did not sign in on either visit.
Continued 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2026
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-20260702133236
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: PURISIMA HILLS
FACILITY NUMBER: 421703748
VISIT DATE: 07/03/2026
NARRATIVE
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LPA verified with Dignity Hospice that this was a volunteer sent by the agency to visit R1. The facility has a visiting policy of 10am-7pm 7 days per week and when a resident is on hospice services the volunteers can come during and out of those hours if needed. The facility, R1 and Dignity have a hospice care plan for R1 and agree to carry out the care plan and allow for visitation with R1. Staff interviews revealed no visitor for R1 was denied entry to see R1. Based on the lack of evidence this allegation is Unsubstantiated at this time.

Exit interview conducted and copy of report printed for Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2