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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425802115
Report Date: 04/02/2025
Date Signed: 04/28/2025 02:41:14 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
02/13/2025 and conducted by Evaluator Garrett Haner-Tomasko
COMPLAINT CONTROL NUMBER: 29-AS-20250213151952
FACILITY NAME:SIMMONS RESIDENTIAL CAREFACILITY NUMBER:
425802115
ADMINISTRATOR:MARIA ZEPEDAFACILITY TYPE:
735
ADDRESS:505 SAINT ANDREW WAYTELEPHONE:
(805) 733-0112
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:4CENSUS: 3DATE:
04/02/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lead Staff - Vincent HernandezTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Financial abuse
Uncleared individual present in facility
Staff did not provide adequate supervision to clients
Staff did not provide a safe environment for clients
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Garrett Haner-Tomasko and Licensing Program Manager (LPM) Kelly Burley conducted a subsequent complaint visit to deliver findings for the above allegations. LPA and LPM met with lead staff Vincent Hernandez and explained the purpose of the visit.

During the investigation, LPA conducted an initial complaint visit on 02/18/2025 from 10:20am to 5:00pm. Personnel from Tri-Counties Regional Center were present during the visit and collaborated on the investigation. During the visit, LPA interviewed staff, clients, licensee, and obtained relevant documents.

(Continued LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
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 5
Control Number 29-AS-20250213151952
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: SIMMONS RESIDENTIAL CARE
FACILITY NUMBER: 425802115
VISIT DATE: 04/02/2025
NARRATIVE
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On the allegation: Financial abuse. It was alleged that Staff 1 (S1) borrowed money from clients in the facility. Personal & Incidental money and logs were reviewed during the visit, and the clients’ money was accounted for. Staff stated they had heard that S1 had collected clients’ rent money and put it in an envelope in the kitchen, instead of locking it up. Client interviews revealed S1 kept their P&I money in the kitchen, not locked up, and stated it was at S1’s home on one occasion. Additionally, there was an occasion where approximately $20 was missing from their P&I money, which later reappeared. Client interviews also revealed S1 regularly asked to borrow money from clients, approximately $20-25 at a time, and S1 paid back the money within a couple of days. Client estimated around $200 was loaned to S1 in total. Clients confirmed although their money was temporarily “borrowed” by S1, they did not have any money or personal property missing. LPA interviewed S1, who at first denied taking money from the clients. S1 stated clients give her their money because they don’t trust other staff, and she took their money home because she doesn’t trust other staff. Later S1 admitted they did borrow money from a client for gas, approximately $20, but gave it back within a couple of days. Additionally, multiple clients stated S1 provided their boyfriend (Person 1, P1) food from the facility on multiple occasions. S1 denied providing P1 with food from the facility. Based on the information obtained, the allegation is deemed Substantiated at this time.

On the allegations: Uncleared individual present in facility, Staff did not provide adequate supervision to clients, and Staff did not provide a safe environment for clients. It was alleged P1, who is not a staff at the facility and was not fingerprint cleared, drove the clients around while S1 slept in the passenger seat. It was also alleged P1 was driving unsafely. Clients stated a few weeks ago there was an incident on an outing in the facility car, where S1 started to not feel well. S1 picked up P1, and P1 proceeded to drive them. They went shopping and had dinner, and P1 drove home. Clients indicated P1 was “driving crazy” and tried to pass cars unsafely. Clients stated they were scared. Clients also stated S1 was asleep in the passenger seat. When interviewed, S1 changed their story, but ultimately confirmed P1 does not have fingerprint clearance and drove the facility car with clients in it. S1 stated they did not believe P1’s driving was unsafe, and stated they were not asleep in the car, but were resting their eyes and opening and closing them.

Staff and clients also stated P1 helped move a bed in the facility on one occasion. Client interviews revealed P1 came inside the facility multiple times when S1 was present, but they were never left alone with P1 inside the facility. S1 changed their story, but ultimately confirmed P1 helped move the furniture in the facility, and had been inside at least two to three times.

(Continued LIC9099-C)

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20250213151952
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: SIMMONS RESIDENTIAL CARE
FACILITY NUMBER: 425802115
VISIT DATE: 04/02/2025
NARRATIVE
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Client interviews also revealed S1 frequently slept on their shift for long periods of time, approximately an hour or two, and clients had to wake S1 up for assistance. S1 denied sleeping during their shift. Interviews revealed on one occasion, two clients were at church, and S1 left the facility for an outing with another client. S1 did not arrive back to the facility in time after the clients returned from church, and they had to wait outside unsupervised by staff.


Interviews also revealed S1 asked clients if they could bring their dog to work, and clients indicated they were scared of dogs and did not want them in their home. However, S1 brought their dog to work anyway. The dog went to the bathroom inside the facility, which a client cleaned up, and freely walked around. Clients indicated they were scared of the dog. Additionally, clients revealed S1 yelled at them on one occasion.

Based on the investigation, an uncleared individual was present in the facility car, with access to clients, while S1 was asleep. Adequate supervision was not provided to clients during the car ride, and on multiple other occasions due to staff sleeping or not being present when clients were home. A safe environment was not provided when P1 drove the car in an unsafe manner that scared clients, when S1’s dog was in the facility scaring clients, and when S1 yelled at clients. Based on the information obtained, the allegations are deemed Substantiated at this time.

Exit interview, deficiencies cited on 9099-D, copy of report given, appeal rights given.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20250213151952
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: SIMMONS RESIDENTIAL CARE
FACILITY NUMBER: 425802115
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/03/2025
Section Cited
CCR
80019(e)(2)
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Criminal Record Clearance. All individuals subject to a criminal record review…shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption…This requirement was not met as evidenced by:
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S1 was terminated on 2/18/2025 and P1 no longer works or is allowed on facility grounds.
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Based on interviews, the licensee did not comply with the section cited above when S1 allowed a non-cleared person, P1, into the facility and to drive clients, which posed an immediate health and safety risk to clients in care.
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Type A
04/03/2025
Section Cited
CCR
80065(a)
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Personnel Requirements. Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement was not met as evidenced by:
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S1 was terminated on 2/18/2025. Licensee agreed to schedule staff training on client personal rights. Licensee will email LPA training date by 4/3/25 and complete staff training by 4/16/25. Licensee will email LPA training and signed staff roster by 4/16/25.
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Based on interviews, the licensee did not comply with the section cited above when S1 slept on their shifts leaving clients unattended, which posed an immediate health and safety risk to clients in care.
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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: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20250213151952
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: SIMMONS RESIDENTIAL CARE
FACILITY NUMBER: 425802115
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/16/2025
Section Cited
CCR
80072(a)(1)
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Personal Rights… each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by:
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S1 was terminated on 2/18/2025. Licensee agreed to schedule staff training on client personal rights and theft and loss policy. Licensee will email LPA training date by 4/3/25 and complete staff training by 4/16/25. Licensee will email LPA training and signed staff roster by 4/16/25.
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Based on interviews, the licensee did not comply with the section cited above when S1 regularly took money from clients, which posed a potential personal rights risk to clients in care.
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Type B
04/16/2025
Section Cited
CCR
80072(a)(2)
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Personal Rights…each client shall have personal rights which include, but are not limited to, the following:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:
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S1 was terminated on 2/18/2025. Licensee agreed to schedule staff training on client personal rights. Licensee will email LPA training date by 4/3/25 and complete staff training by 4/16/25. Licensee will email LPA training and signed staff roster by 4/16/25.
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Based on interviews, the licensee did not comply with the section cited above when S1 scared clients by bringing their dog to the facility and when they allowed a non-staff to drive clients, which posed a potential health and safety risk to clients in care.
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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: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5