<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425801403
Report Date: 06/06/2025
Date Signed: 06/06/2025 12:58:31 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
06/04/2025 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 29-AS-20250604140707
FACILITY NAME:ALEJANDRO'S RCFEFACILITY NUMBER:
425801403
ADMINISTRATOR:VENIER D. ALEJANDROFACILITY TYPE:
740
ADDRESS:1130 GRAPEVINE ROADTELEPHONE:
(805) 349-9446
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:6CENSUS: 1DATE:
06/06/2025
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Venier Alejandro, LicenseeTIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility restrained resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the facility above to issue final findings. LPA met with Licensee Venier Alejandro and explained the purpose of the visit. During the initial visit on 6/5/25 LPA Rankin toured the facility, interviewed staff, viewed video of resident behaviors, and obtained relevant documents. Additional interviews were conducted with relevant parties on 6/4/25 and 6/5/25.

On the allegation – Facility restrained resident:
It was alleged on two occasions Resident 1 (R1) was observed with a fabric wrap around R1’s waist and that R1 was strapped into the wheelchair to restrain R1 from getting out of the wheelchair. During LPA’s visit on 6/5/25, both licensee and Staff 1 stated, “yes” to R1 having a seatbelt on when in the wheelchair. In both separate interviews the care staff stated it was out of concern for R1 falling, especially due to R1’s constant movements.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025
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-20250604140707
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: ALEJANDRO'S RCFE
FACILITY NUMBER: 425801403
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/06/2025
Section Cited
CCR
87608(a)(1)
1
2
3
4
5
6
7
(a)(1) Postural supports shall be limited to…soft ties, used to achieve proper body position and balance…or to position rather than restrict movement…
1
2
3
4
5
6
7
Licensee agrees to conduct a one-hour Postural Support and one-hour Personal Rights training with all staff and provide a sign in sheet to the LPA within 30 calendar days, of all staff who attended, the dates and hours the staff was trained and who provided the training.
8
9
10
11
12
13
14
Based on interviews and records review, the licensee did not comply with the section cited above when staff used a wheelchair seat belt to keep resident from standing up, which posed a personal rights risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20250604140707
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: ALEJANDRO'S RCFE
FACILITY NUMBER: 425801403
VISIT DATE: 06/06/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Concern was that R1 would fall on R1’s face and cause injury. LPA was allowed to review a video showing that R1, while seated in the wheelchair tried to get out of the wheelchair multiple times. In the video R1 was seen scooting while in the wheelchair, R1 swung arms wide, bent fully at the waist and was reaching around their legs and wheels for no clear reason. R1 was not verbal in the video, and did not express any verbal requests, just constant movement and trying to grab at items around them and various attempts to get out of the chair. Interviews and record review confirmed R1 is not able to self-release their wheelchair seat belt.

Interview on 6/5/25 at 4:46 p.m. with nurse practitioner stated they know R1 to be aggressive, can hit, and has extreme behaviors, but at this time, they do not believe an order was approved to allow for seat belts as R1 was placed into care at the facility while practitioner was unavailable.

Based on LPAs observations, interviews conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED.
Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC9099-D).

Exit interview conducted, appeal rights discussed, and a copy of this report issued.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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