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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425802136
Report Date: 09/02/2025
Date Signed: 09/02/2025 05:49:12 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
07/28/2025 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 29-AS-20250728132202
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: 11DATE:
09/02/2025
UNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Team Lead Unlicensed, Alexandria NealTIME COMPLETED:
06:15 PM
ALLEGATION(S):
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Staff did not provide adequate supervision to clients in care
Staff did not ensure there was sufficient foods available at the facility for clients in care
Staff refused to provide transportation services to clients in care resulting in missed appointments
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the above facility to issue final findings. LPA met with Team Lead Unlicensed, Alexandria Neal and explained the purpose of the visit.

During the initial visit on 7/31/25, LPA toured kitchen, bathrooms, bedrooms, and common areas, reviewed cleanliness of areas, interviewed team lead, 3 clients, and 4 staff, and requested copies of various documents, and photos of areas were taken. LPA did phone interviews for 2 staff on 8/12/25. On 9/2/25 LPA interviewed 4 additional clients and 5 additional staff and toured the facility. Additional photos were taken during the tour.

On the allegation – Staff did not provide adequate supervision to clients in care
It was alleged that staff are on their phones, not engaged with clients, clients are being allowed into the building without searching their items and room checks are inconsistent or rushed. Continued on 9099-C pg 1
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 8
Control Number 29-AS-20250728132202
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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Throughout the 2 visits LPA interviewed 8 clients, all claimed that staff have been helpful and supportive, and they have received assistance in getting resources. Observation of staff during LPA visit are staff are mainly in the “hub” which is the main office for support staff, LPA has observed that clients frequently engage with staff through the hub windows. Clients are usually in their rooms, outside, in the dining area or on the community computer.

LPA reviewed staff schedules, there is a couple of vacant positions, but those are being covered by on-call staff and management. LPA noted that in various offices where staff are set-up there are screens showing all common inside and outside areas of the facility to assist with supervision. During interviews it was noted by LPA that staff will look to the screen frequently to observe client activities and whereabouts.

Staff and clients interviewed did not provide any evidence that staff and clients do not engage. A list of group activities is posted and provided to clients. One interview stated that some staff are not as engaged as others, but nothing proved this allegation, at this time is supported.

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.

On the allegation – Staff did not ensure there was sufficient foods available at the facility for clients in care

It was alleged that clients have complained about there not being enough food, and that clients have asked for seconds of dinner and have been told no.
Clients interviewed stated they receive enough food during meals, they are aware that other snacks are available upon request, and fresh fruit is always out in the dining area. All 8 clients interviewed during the 2 visits to the facility stated they had enough and were able to get more food if they needed.

Staff interviewed stated they shop 2 times a week, that they try to prepare fresh meals, enough for what is needed. LPA observed that snacks and fresh fruit are available. Staff also stated if someone needed more, they would make them a sandwich if there were no leftovers from the meal.

LPA noted there are no leftovers in the refrigerator and that items being stored for the next meal seem to be just enough for a serving.

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. Continued on 9099-C pg 2
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: 2 of 8
Control Number 29-AS-20250728132202
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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On the allegation – Staff refused to provide transportation services to clients in care resulting in missed appointments

It was alleged that clients have missed appointments and have been told no for rides. LPA interviewed 8 clients during 2 visits to the facility all have stated at this time, they are unaware of anyone missing appointments, only 2 had appointments coming up, one client stated they found a ride already, and another stated that the facility helped schedule them a ride.

Staff interviewed stated that there are times where staff will provide a ride to appointments, they try to bundle the appointments together if they can. They also stated the clients, if they notify staff early enough, can get rides scheduled through Ventura Transit Services.

Without evidence and witnesses confirming instances of concern, based on a review of the policies and procedures of the facility, there is not enough information to support this allegation.

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 printed.

pg 3
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: 8 of 8
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
07/28/2025 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 29-AS-20250728132202

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: 11DATE:
09/02/2025
UNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Team Lead Unlicensed, Alexandria NealTIME COMPLETED:
06:15 PM
ALLEGATION(S):
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Facility is not kept clean
Staff did not safeguard clients’ confidential information
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the above facility to issue final findings. LPA met with Team Lead Unlicensed, Alexandria Neal and explained the purpose of the visit.

During the initial visit on 7/31/25, LPA toured kitchen, bathrooms, bedrooms, and common areas, reviewed cleanliness of areas, interviewed team lead, 3 clients, and 4 staff, and requested copies of various documents as well as took photos of observations. LPA did phone interviews for 2 staff on 8/12/25. On 9/2/25 LPA interviewed 5 additional clients and 6 additional staff and toured the facility. Additional photos were taken during the tour. Continued on 9099-C p1

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: 3 of 8
Control Number 29-AS-20250728132202
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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On the allegation – Staff did not safeguard clients’ confidential information
It was alleged that staff talk about people’s private information in the open main office or with the medication room doors open, so clients can hear confidential conversations.

During LPA’s visit on 9/2/25 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.

Based on LPA’s interviews conducted, 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).

On the allegation – Facility is not kept clean

It was alleged that the clients rooms and bathrooms stay dirty, sometimes for days. It was also alleged that the kitchen refrigerator is dirty and full of expired foods.

Regarding the refrigerator and expired foods, all refrigerators were viewed, and all were clean of spills and grime, also all fresh food was examined, and all vegetables, meats, and cheeses were not expired, moldy, or odorous. Dry storage was also viewed, with no expired or damaged goods. Continued on 9099-C p 2
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: 4 of 8
Control Number 29-AS-20250728132202
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 the tour of the facility LPA noted 3 client restrooms, one without a shower, two with showers. The restrooms with showers had grime and dirt noticeably throughout the shower walls and flooring. Under the shower chair that is mounted to the wall in one of the restrooms was, notable grime, deep brown, and orange in color all noted on the underneath of the chair and the tile wall below it. One shower head has thick hard water staining and deposit. Tile walls do not appear to have been scrubbed well in a long time due to depositing of grime, water staining, brown and black, and rust colored grout. The caulking under both toilets is yellow and brown. Corners behind the toilet had brown deep dirt, which appeared to be thick and not cleaned in a while. Both vents in the restrooms need to be vacuumed and dusted, one vent was slightly hanging as if it had been removed and not replaced correctly. During LPA’s return visit on 9/2/25, none of the noted issues above have been addressed, items still appear to need deep cleaning. Lead staff did provide documentation that the dryer vent is scheduled to be cleaned on September 16th and that a discussion with the cleaners regarding a deep cleaning was discussed and the administrator was told that would be scheduled when the work order through the County gets processed. As of today, no further discussion has been had and no scheduled cleaning has been made.

Facility kitchen had a water leak below the kitchen sink, unsure if it is the sink or the refrigerator, but the boards below are falling apart and appear to be swollen particle board, a mildew smell was detected. The flooring in the kitchen in the corners had built up grime, the inside of kitchen utensil drawers and cabinet doors had sticky substances and staining. The bottom shelf of kitchen cabinets does not appear to have been cleaned due to food particles and dirt. The stove window has not been cleaned and a grey and white ash like substance was noted on the bottom of the stove. During visit on 9/2/25, all areas were reviewed, while the mildew smell and leak appear to be fixed, the cleaning of the kitchen has not been done.
Continued on 9099-C p 3
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: 5 of 8
Control Number 29-AS-20250728132202
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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The dining room had a noticeable spill stain in the corner behind the table. LPA found that lockers had been stored there a few weeks prior and the spill and dirt are most likely from the time of the unit being stored there. Staff stated that cleaners had deep cleaned the floors in the past couple of weeks, after those lockers were moved. Team Lead stated the contract cleaners should have cleaned that when they were cleaning the floors. LPA noted on return visit of 9/2/25 that the spilled area in the dining room is still there.

Air intake vents were noted in various common areas of the facility as clean, but intake vents in 5 resident rooms were noted as dirty, clogged with dust.

Interviews conducted with all clients’ state that the restrooms are not clean but had no complaints about any other areas in the facility.

Based on LPA’s observations, and interviews conducted, the preponderance of evidence standard has been met; therefore, the above allegation 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.

pg 4
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: 6 of 8
Control Number 29-AS-20250728132202
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)
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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:
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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.
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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.
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Image of medicaiton area updated will be sent to LPA, and a statement of discussion with staff will be provided to LPA from administrator.
Type B
10/02/2025
Section Cited
CCR
81087(a)
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81087 BUILDINGS AND GROUNDS(a)The facility shall be clean, safe, sanitary...at all times for the safety and well-being of clients, employees and visitors.
This requirement has not been met as evidenced by:
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Licensee has initiated work orders to clean the areas noted in the complaint through the Santa Barbara County contract. Additionally a review of the current contract is being done by the administrator to work on scheduling a routine deep clean of the facility.
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Based on observation the licensee did not comply with the regulation above when they failed to clean dirt, grim, vents, and flooring in the common areas, including the kitchen and toilet areas. This poses a potential health and safety risk to clients in care.
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If contract does not allow for such then Telecare will need to work with the County to ammend contract or provide addtional services.
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)
Page: 7 of 8