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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425802136
Report Date: 07/02/2026
Date Signed: 07/02/2026 04:26:11 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
06/17/2026 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 29-AS-20260617134519
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:
07/02/2026
UNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Alexandria NealTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not ensure complete, current and accurate records were recorded for resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the facility above to issue final findings. LPA met with Alexandria Neal, Clinical Director and Desgniee, and explained the purpose of the visit.

During the initial visit on 06/19/26 and 7/1/26 LPA Rankin interviewed staff, and reviewed relevant records.

On the allegation: Staff did not ensure complete, current and accurate records were recorded for resident

It was alleged that a client received records of their time at the facility; however, the client reported that the records were inaccurate and appeared to be falsified. The complaint included concerns regarding dates, observations, and descriptions of care and behaviors that the client disputes.

Continue on 9099-D
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
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 5
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
06/17/2026 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 29-AS-20260617134519

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:
07/02/2026
UNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Alexandria NealTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not safeguard resident records
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the facility above to issue final findings. LPA met with Alexandria Neal, Clinical Director and Desgniee, and explained the purpose of the visit.

During the initial visit on 06/19/26 and 7/1/26 LPA Rankin interviewed staff, and reviewed relevant records.

On the allegation: Staff did not safeguard residents’ records

It was alleged that some of the medical records are missing. The complainant indicates that the facility Administrator could not provide an explanation and that they do not have the missing records.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20260617134519
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: 07/02/2026
NARRATIVE
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The LPA interviewed staff and reviewed all available records. It is unclear whether the missing urinalysis records the complainant referenced were expected to have been generated while the client was in the facility or prior to admission. The LPA located the “New Admit” urine toxicology log with result in the file. Correspondence with the client also referenced records being faxed from the hospital, and the hospital discharge paperwork confirms that a urine toxicology screen was completed prior to admission.

A review of charting notes shows on 7/22/25, a note documented “…requesting… LABs if available – received/uploaded on SmartCare.” Staff reviewed the electronic file and located the uploaded documents. The LPA is unable to determine which documents were originally provided to the client; therefore, both copies found during the visit will be sent to the client. The second document, while available, is stored in the county system and is a record that could also have been obtained directly from the medical agency that created it.

Based on the record review and staff interviews, the preponderance of evidence has not been met. Therefore, the allegation that staff failed to safeguard residents’ records is unsubstantiated.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20260617134519
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2026
Section Cited
CCR
81070(a)
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81070 CLIENT RECORDS (a) The licensee shall ensure that a separate, complete, and current record is maintained in the facility for each client.

This requirement is not met as evidenced by:

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The Licensee will reconcile the inhouse charting with the Progress Notes record system and remove any notes that reference other clients specifically the progress note dated 10/16/25, that belong to other clients. The Licensee will update the client’s progress notes with missing dates (8/13/25, 8/26/25, and 9/12/25) and ensure all records are accurate. The Licensee will email the LPA copies of all corrected notes for the above dates by 7/31/26.
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Based on interviews and record review, the licensee did not comply with the section cited above. Review of the client’s records showed that one progress note referenced another client, and 3 days of progress notes(8/13/25, 8/26/25, and 9/12/25) were missing. This posed a potential personal rights and health and safety risk to residents 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.
SUPERVISOR'S NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20260617134519
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: 07/02/2026
NARRATIVE
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During the visit on 7/1/26 and 7/2/26, the LPA conducted a full review of the client’s record. The documentation identified by the complainant was located and examined. During the review, the LPA and staff discovered duplicate progress notes, when reviewed it was determined that the duplicates are actually missing documents for 8/13/25, 8/26/25, and 9/12/25. It was also discovered that at least one full Progress Note on 10/16/25 belonged to a separate client.

The client also stated that some documents appeared to be outside the time frame of their stay. The LPA reviewed these items and confirmed that documents reviewed dated prior to admission were standard pre admission requirements, such as health screenings and physician authorizations. No charting or progress notes were found that indicated care or observations being documented before the client’s admission date.

A note referencing PRN medication taken due to migraine could not be validated on the Medication Administration Records (MAR) and there was no PRN log. This note cannot be deterred as in accurate due to limited documents.

Entries disputed by the client could not be independently validated as inaccurate; however, the LPA requested the facility to document the client’s concerns in the record so that future reviewers are aware the client contests those entries.

Based on the evidence obtained through interviews, record review, and supporting documentation, the preponderance of evidence standard has been met. The LPA confirmed that inaccurate Progress notes were uploaded in the clients records and missing progress notes were discovered, which does not meet the requirement for facilities to maintain complete, current, and accurate records for each resident. Therefore, the allegation is substantiated.

A deficiency is cited on the attached LIC 9099 D.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5