425802136-9-2-2025-29-AS-KBUY-DLUPDA-20250925111315

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802136
Report Date: 09/02/2025
Date Signed: 09/02/2025 05:40:03 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
08/25/2025 and conducted by Evaluator Melisa Rankin

COMPLAINT CONTROL NUMBER: 29-AS-20250825124415

FACILITY NAME:	TELECARE CARMEN LANE		FACILITY NUMBER:	425802136
ADMINISTRATOR:	HANNA DIAZ		FACILITY TYPE:	772
ADDRESS:	212 WEST CARMEN LANE STE 201		TELEPHONE:	(805) 212-7680
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93458
CAPACITY:	12	CENSUS: 11	DATE:	09/02/2025
		UNANNOUNCED	TIME BEGAN:	09:31 AM
MET WITH:	Team Lead Unlicensed, Alexandria Neal		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Staff are not dispensing medication as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rankin conducted a 10-day complaint visit to the above facility. LPA met with Team Lead Unlicensed, Alexandria Neal, and explained the reason for the visit.
During the visit, LPA toured the facility, while walking around LPA spoke with 5 clients, and 6 staff. LPA also reviewed medication records.

On the allegation – Staff are not dispensing medication as prescribed
It was alleged that staff are not distributing medication on time.
LPA interviewed 5 clients and 6 staff, 2 of which are nursing staff who dispense medication, medication processes were discussed and client’s medication was reviewed. Review of records and interviews conducted do not show evidence to support that medication is given outside of doctor’s orders. All stated the same, that nursing staff are consistent with dispensing medication, that staff prompt clients when needed, and as a last resort will take medications to clients to ensure medication is taken unless clients refuse.
Based on LPA’s observations, interviews conducted, and record reviews, at this time the preponderance of evidence standard has not been met; therefore, the above allegation is found to be UNSUBSTANTIATED.

Exit interview conducted, copy of report provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025

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 4

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
08/25/2025 and conducted by Evaluator Melisa Rankin

COMPLAINT CONTROL NUMBER: 29-AS-20250825124415

FACILITY NAME:	TELECARE CARMEN LANE		FACILITY NUMBER:	425802136
ADMINISTRATOR:	HANNA DIAZ		FACILITY TYPE:	772
ADDRESS:	212 WEST CARMEN LANE STE 201		TELEPHONE:	(805) 212-7680
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93458
CAPACITY:	12	CENSUS: 11	DATE:	09/02/2025
		UNANNOUNCED	TIME BEGAN:	09:31 AM
MET WITH:	Team Lead Unlicensed, Alexandria Neal		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Staff are violating clients personal rights

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20250825124415

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: 09/02/2025

NARRATIVE

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During LPA discussion with staff and clients, it was confirmed by both groups that they have overheard or witnessed discussions regarding client’s personal business both in the main central office known as the “HUB” and while waiting for medication outside the medication room. Clients state that they can hear discussions, both when clients are speaking with staff, or when staff are discussing things together. There is a concern for the privacy of their diagnosis, their medications, and their medical history. Clients stated there is concern that they are overhearing discussions of others and a fear that their information is being discussed where others can hear as well.

Interview with staff note that maintaining privacy can be challenging based on the open layout of the "HUB" which has 3 open windows, two with partial plexi glass. Multiple staff state that even when they move shift change discussions to the dining room and close the door, the layout of the room does not allow for privacy if clients are right outside the door. Staff also explained that the level of privacy can vary from client to client, so staff need to communicate each clients preferences. Staff did not admit to purposely having open conversations, but all presented the challenges to how the conversations can be overheard.

It was also stated by multiple clients that during the night shift, laughter can be heard, but the clients who were interviewed stated they do not hear loud noises, or loud discussions, just occasional laughter and that those interviewed did not have an issue with the sounds. Clients did not express concern of staff not meeting their needs for assistance, except for the need for their privacy to be maintained.

Based on LPA’s interviews, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED.
Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (LIC 9099-D).

Exit interview conducted, copy of report and appeal rights issued.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20250825124415

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: 09/02/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/02/2025 Section Cited CCR 81072(a)(1)	1 2 3 4 5 6 7	81072 PERSONAL RIGHTS (a)Each client shall have personal rights which include...(1)To be accorded dignity in his/her personal relationships with staff and other persons. This requirement has not been met as evidenced by:	1 2 3 4 5 6 7	Administrator will advise staff that all shift changes should be done in the dining room area, administrator will have seating in medication area removed to ensure that one client is assisted in the medication area at a time. Additional discussions during meetings will be done to ensure staff are reminded of the sensitive topics and personal rights of all clients.
	8 9 10 11 12 13 14	Based on interviews 7 out of 11 people interviewed have stated that clients privacy can be overheard by other clients even thought it may be unintentional. This poses a potential health and safety risk to clients in care.	8 9 10 11 12 13 14	Image of medicaiton area updated will be sent to LPA, and a statement of discussion with staff will be provided to LPA from administrator.
	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: 09/02/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025

LIC9099 (FAS) - (06/04)

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