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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425802138
Report Date: 10/30/2025
Date Signed: 10/30/2025 04:37:07 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
04/15/2025 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 29-AS-20250415160409
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: 10DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Alexandria Neal, Team Lead UnlicensedTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility staff did not ensure that medications were inaccessible to clients.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rankin conducted an unannounced subsequent complaint visit to issue final findings on the allegation above. LPA met with Alexandria Neal, Team Lead Unlicensed and explained the purpose of the visit. LPA obtained documents, interviewed staff on 4/10/25, 4/17/25, and 7/31/25. LPA interviewed clients on 4/17/25 and 7/31/25. LPA conducted phone interviews with staff on 5/22/25 and 7/31/25.

Collateral visit was conducted on 6/3/25 where additional documents and interviews were conducted.

On the allegation: Facility staff did not ensure that medications were inaccessible to clients.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
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 3
Control Number 29-AS-20250415160409
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: 10/30/2025
NARRATIVE
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It was alleged that staff have left the medication room door open and unattended.
On 04/10/25, while investigating an unrelated complaint, LPA toured the medication room, noted the facility has 2 locked options available, both the locking of the door to the medication room, and a lock on the medication cabinet within this room. LPA observed the medication room door locked, but the internal cabinet where medication is kept was unlocked. On 04/17/25 and 07/31/25, LPA observed the medication room to be locked and attended. During the 04/17/25 visit, staff provided a tour and confirmed all cabinets were locked. The medication room door is a Dutch-style door with an automatic lock requiring a key card or medication room specific key. The upper half can open independently for medication dispensing.

LPA reviewed Telecare Policy titled Medication Storage, #MM-2000 which states under “Procedure…4. All drug supplies and medications on site are stored behind two (2) locked doors (keyed room and in locked med cabinet).”
In April, a copier was located in the medication room. Staff stated they believed the door was left open by others accessing the copier. By 07/31/25, the copier had been removed. LPA was also told during 7/31/25 visit that the medication room on occasion is used for medical zoom appointments when no other room is available.
On 05/22/25, 06/03/25, and 07/31/25, lead and management staff reported observing the medication room left unlocked. One noted the upper half of the door was sometimes left open, allowing access by reaching over the locked lower half. On 06/03/25, LPA reviewed a “Manager note” documentation confirming staff were observed leaving the door open on 04/07/25 and 04/08/25.
Based on observation, interviews, and records, the allegation is substantiated. There is a preponderance of evidence that staff left the medication room door unlocked and unattended.
Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was 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: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 29-AS-20250415160409
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: 10/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/01/2025
Section Cited
CCR
81075(k)(1)
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81075 Health-Related Services (k)The following requirements shall apply to medications which are centrally stored:(1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.
This requirement is not met as evidenced by:
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Facility will review their internal polices regarding securing medication, and possibly update auditing timeframes and procedures. They will conduct a review of this policy with all staff and provide signed In Service Training sheets along with a copy of the policy(s) reviewed to licensing.
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Based on observations, interviews, and record reviews, the licensee did not comply with the section cited above. On one occasion, a medication cabinet was found unlocked. Additionally, staff were observed and documented leaving the medication room door unlocked and unattended, which poses a potential health, safety or personal rights risk to persons 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: 10/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
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