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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425802138
Report Date: 10/31/2025
Date Signed: 10/31/2025 03:40:36 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
07/28/2025 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 29-AS-20250728132138
FACILITY NAME:TELECARE AGNES AVENUEFACILITY NUMBER:
425802138
ADMINISTRATOR:HANNA DIAZFACILITY TYPE:
772
ADDRESS:116 AGNES AVENUETELEPHONE:
(805) 457-3724
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:10CENSUS: 9DATE:
10/31/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Alexandria NealTIME COMPLETED:
04:00 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 administrator, 3 clients, and 3 staff, and requested copies of various documents, and photos of areas were taken. On 10/31/25 LPA interviewed 5 additional clients and spoke with staff onsite and toured the facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
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 9
Control Number 29-AS-20250728132138
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 AGNES AVENUE
FACILITY NUMBER: 425802138
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/01/2025
Section Cited
CCR
81087(a)
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81087 BUILDINGS AND GROUNDS (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:

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Facility will provide plan for ensuring facility cleaning is maintained, specifically regarding the restrooms and kitchen. If contract from county is not updated, facility must report alternate means for providing cleaning of these areas
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Based on observation and interviews the licensee did not comply with the regulation above when they failed to clean the inside of kitchen cabinets and drawer where food storage and preparation items are kept and newly remodled restroom after 2 months already had brown grime and buildup in showers, common areas have unclean baseboard and window surfaces. This poses a potential health and safety risk to clients in care.
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Type B
12/01/2025
Section Cited
CCR
87070(c)(1)(2)
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81070 Client Records
(c) All information and records obtained from or regarding clients shall be confidential.
(1) The licensee shall be responsible for safeguarding the confidentiality of record contents.
(2) …the licensee and all employees shall not reveal or make available confidential information. This requirement is not met as evidenced by:
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Facility will provide LPA with documentation of training regarding the safeguarding of clients confidential information. Facility has already moved the whiteboard and LPA observed office door were closed more and desks inside were clear of confidential items.
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Based on observation and interviews clients personal information is not being safeguarded from view, and 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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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: 10/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 9
Control Number 29-AS-20250728132138
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 AGNES AVENUE
FACILITY NUMBER: 425802138
VISIT DATE: 10/31/2025
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.

This is the third complaint received regarding the safeguarding of client confidentiality at this facility.

Facility tours were conducted on 4/15/25, 4/17/25, and 7/31/25. During these visits, LPA observed that the main support staff office, referred to as the “hub,” contained a whiteboard displaying client initials, room numbers, and diagnoses. This board was located on the right wall and was visible from the doorway. Photographs of the board were taken on 4/15/25 and 7/31/25. The whiteboard was not covered and could be easily seen during interactions between staff and clients at the hub door. As of 10/31/25 the whiteboard has been removed and is now closable and not visible by the doorway.

Staff interviews confirmed that maintaining confidentiality is challenging due to the hub’s central location and frequent client interactions at the doorway. While staff did not report intentionally discussing confidential information in open areas, they acknowledged the difficulty in preventing conversations from being overheard.

Interviews with prior management who have now since moved on and a review of internal “Manager Note” further confirmed that there have been instances where staff left Protected Health Information (PHI) documents visible when stepping away from the hub. Additionally, it was noted that PHI has been left visible on desks when clients approach the hub door to speak with staff, increasing the risk of unintentional disclosure.

Previous complaints received on 4/10/25 and 4/16/25 raised similar concerns about visible client information and conversations occurring in areas where others could overhear.

Based on LPA’s observations, staff and management interviews, documentation review, and the recurrence of similar complaints, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (see LIC 9099-D).
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 9
Control Number 29-AS-20250728132138
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 AGNES AVENUE
FACILITY NUMBER: 425802138
VISIT DATE: 10/31/2025
NARRATIVE
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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.

During the facility inspection, all refrigerators were observed to be clean and free of spills or grime. All perishable food items, including vegetables, meats, and cheeses, were examined and found to be within expiration dates, with no signs of spoilage, mold, or odor. Dry food storage areas were also reviewed and contained no expired or damaged goods.

However, the interior of kitchen utensil drawers and cabinet doors had visible sticky residues and staining. The bottom shelves of kitchen cabinets, where pots, pans, and food storage containers are kept, contained food particles and dirt, indicating they had not been recently cleaned. During the follow-up visit on 10/30/25, LPA reviewed that inside cabinets had been wiped and were free of dirt and food particles.

During the initial visit on 7/31/25, three client restrooms were observed, two of which included showers. One restroom was under construction at the time. The second restroom with a shower had been remodeled within the past two months. However, due to usage by approximately 7–10 residents, there was a noticeable buildup of grime and dirt on the shower walls and flooring. The tile walls appeared not to have been scrubbed, as evidenced by water staining and brown, black, and rust-colored grout.

The handrail, designed with a trough-style layout to accommodate the mental health needs of residents, was holding standing water and appeared unclean. Additionally, the bathroom sink showed peeling paint or enamel, an issue previously discussed in the 2024 annual inspection. A common area chair, not intended for shower use, was present in the bathroom; its metal legs showed signs of orange staining, likely due to water exposure.

During the follow-up visit on 10/30/25, all but the peeling paint on the bathroom sinks had been addressed. The restroom handrail has been removed as all clients are ambulatory, the walls appear to have been cleaned since last visit but still show some signs this is not done regularly, and no scheduled cleaning or corrective action had been communicated by the facility at the time of the visit as they are waiting for a response for a county contract.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 9
Control Number 29-AS-20250728132138
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 AGNES AVENUE
FACILITY NUMBER: 425802138
VISIT DATE: 10/31/2025
NARRATIVE
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The LPA noted on 7/31/25 throughout the facility that baseboards, window coverings and window seals had not been dusted, noticeable by thick dust caked with some liquid. Visit on 10/30/25, it appears that some baseboards were wiped, but not all, the tops of door frames were noticed to have thick dust, window seals in common areas appear cleaned, but in bedrooms there is a collection of dust and particles.

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.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 9
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-20250728132138

FACILITY NAME:TELECARE AGNES AVENUEFACILITY NUMBER:
425802138
ADMINISTRATOR:HANNA DIAZFACILITY TYPE:
772
ADDRESS:116 AGNES AVENUETELEPHONE:
(805) 457-3724
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:10CENSUS: 9DATE:
10/31/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Alexandria NealTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not safeguard clients’ confidential information
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 administrator, 3 clients, and 3 staff, and requested copies of various documents, and photos of areas were taken. On 10/31/25 LPA interviewed 5 additional clients and spoke with staff onsite and toured the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 9
Control Number 29-AS-20250728132138
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 AGNES AVENUE
FACILITY NUMBER: 425802138
VISIT DATE: 10/31/2025
NARRATIVE
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On the allegation – Staff did not provide adequate supervision to clients in care
Throughout three facility visits, LPA interviewed 14 clients. All clients reported that staff have been helpful, supportive, and responsive to their needs, including assistance with accessing resources. During observations, staff were seen meal prepping, assisting clients, and engaging with them in various areas of the facility, including the common areas and the staff support office (referred to as the “hub”). Clients were observed spending time in their rooms, outside, or in the TV room.

LPA reviewed staff schedules and noted that while there are a few vacant positions, coverage is being maintained through the use of on-call staff, overtime by full-time staff, and support from management. The facility has security monitors in multiple staff offices that display live video of all common indoor and outdoor areas, which staff use to assist with supervision. LPA observed staff frequently checking these monitors to remain aware of client activity and location.

Interviews with both staff and clients did not yield any evidence that staff are disengaged or that clients feel unsafe. Clients consistently reported feeling supported and stated that their needs are being met.

Additionally, while staffing levels currently meet the required ratios, LPA notes that the minimum staffing ratio may not be sufficient to fully implement all aspects of the facilities program’s plan of care, including consistent engagement, supervision, and therapeutic interventions. Additional staffing would enhance the program’s ability to meet its full scope of services and expectations.

Based on LPA’s observations, interviews, and record reviews, the preponderance of evidence standard has not been met. Therefore, the allegation is UNSUBSTANTIATED.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 9 of 9
Control Number 29-AS-20250728132138
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 AGNES AVENUE
FACILITY NUMBER: 425802138
VISIT DATE: 10/31/2025
NARRATIVE
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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 common area. All clients interviewed stated they had enough and were able to get more food if 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.

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 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.

Staff interviewed stated that transportation is provided when possible, and efforts are made to coordinate multiple appointments together or transport multiple clients at once to remain within staffing ratios. Staff also reported that clients are encouraged to notify staff in advance so that transportation can be arranged through Ventura Transit Services, or clients may use public transportation, rideshare services, or walk if the destination is nearby.

LPA interviewed multiple clients. None reported missing appointments due to lack of transportation. However, LPA observed a client cancel an optometry appointment due to same-day notice. Staff confirmed they were unable to arrange transportation in time and lacked available staff to transport the client.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 9
Control Number 29-AS-20250728132138
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 AGNES AVENUE
FACILITY NUMBER: 425802138
VISIT DATE: 10/31/2025
NARRATIVE
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While there is no direct evidence or consistent witness testimony confirming that clients are routinely denied transportation or missing appointments as a result, this incident suggests that limited staffing may impact the facility’s ability to respond to last-minute transportation needs. It is reasonable to conclude that if additional staff had been available, the client may have been able to attend the appointment.

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.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 9