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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425802136
Report Date: 04/17/2025
Date Signed: 04/17/2025 04:15:57 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
04/14/2025 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 29-AS-20250414110506
FACILITY NAME:TELECARE CARMEN LANEFACILITY NUMBER:
425802136
ADMINISTRATOR:HANNA DIAZFACILITY TYPE:
772
ADDRESS:212 WEST CARMEN LANE STE 201TELEPHONE:
(805) 212-7680
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:12CENSUS: 12DATE:
04/17/2025
UNANNOUNCEDTIME BEGAN:
02:18 PM
MET WITH:Alexandria NealTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff are not meeting resident's dietary needs.
Staff are not properly supporting client requiring ambulatory assistance devices.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rankin conducted an initial 10-day complaint visit to the facility above. LPA met with Alexandria Neal, Team Lead Unlicensed, and explained the purpose of the visit.

During the investigation, LPA Rankin conducted interviews with Team Lead, clients, reviewed 12 client folders, reviewing all Physician Reports (LIC 602s). LPA toured facility, including the kitchen, dining room and the "Hub" which is the Residential Councilor (RC) office, where the snack cabinet is located.

On the allegation: Staff are not meeting resident's dietary needs. LPA observed the facility to be in compliance with regulation, 81076 (a)(1) “All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients.” LPA observed two (2) cupboards full of items, two (2) refrigerators with meats, fruits, vegetables, and condiments, and 3 freezers with a variety of frozen items. LPA observed the snack cabinet located in the RC’s room, clients are aware they can come request snacks throughout the day. LPA observed a menu plan on the wall in the RC’s office as well as a white board stating the menu for the day in the dining room for clients to view. Clients interviewed stated they are getting the food quantity and quality they need, and they are aware that they can request leftovers if any are available, or they can get fruit or a snack. Fruit is available at any time, and it is located for client access located in the dining room.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
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-20250414110506
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: TELECARE CARMEN LANE
FACILITY NUMBER: 425802136
VISIT DATE: 04/17/2025
NARRATIVE
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Based on observation and interviews, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

On the allegation: Staff are not properly supporting client requiring ambulatory assistance devices. LPA reviewed all 12 client files. Files reviewed showed that all clients are ambulatory, and none require assistance completing activities of daily living or assistance in mobility. The facility is approved for 12 ambulatory residents only, therefore no client requiring the use of mechanical aids such as wheelchairs, walkers, or crutches can be admitted.

Based on observation, record review and interviews, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted, copy of report given.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2