425850568-9-25-2025-29-AS-KBUY-DLUUSL-20250925155030

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850568
Report Date: 09/25/2025
Date Signed: 09/25/2025 10:30:14 AM

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
08/12/2025 and conducted by Evaluator Melisa Rankin

COMPLAINT CONTROL NUMBER: 29-AS-20250812142105

FACILITY NAME:	A CASA BLUE LAKE		FACILITY NUMBER:	425850568
ADMINISTRATOR:	SORIANO, APRILYN A.		FACILITY TYPE:	735
ADDRESS:	1029 BLUE LAKE DRIVE		TELEPHONE:	(650) 544-1485
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY:	4	CENSUS: 4	DATE:	09/25/2025
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Aprilyn Soriano		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff are not correctly handling medication
Staff did not meet resident's needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit with Tri-County Regional Center Wesley Marking to issue final findings on this investigation. LPA met with Aprilyn Soriano and explained the purpose of the visit.

During the investigation, LPA did an initial visit on 8/13/2025, where LPA conducted an interview with the administrator and obtained relevant documents. Additional interviews and documents were reviewed from the past month which provided relevant information in regard to the allegations. Interviews done on 7/10/25 with Witness (W1), the administrator and an interview on 8/1/25 and again on 9/24/25 with Witness 2 (W2). Earlier interviews were prompted by an incident report received from the facility on 7/10/25. LPA and QAS also observed medication records and containers during visit on 9/25/25 to confirm orders.

On the allegation: Staff are not correctly handling medication
Allegation that staff are overdosing or miss handling Client 1’s (C1) medication due to C1 speaking with Reporting Party (RP) and RP states “(C1) speech during the conversation became slurred and unclear.” LPA and QAS did an review of C1’s medication, all records are up to date, counts were correct, there is no evidence at this time of overdosing. Continue 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

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 6

Control Number 29-AS-20250812142105

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: A CASA BLUE LAKE	FACILITY NUMBER: 425850568
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/25/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/24/2025 Section Cited CCR 80075(b)	1 2 3 4 5 6 7	80075(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The licensee/administrator shall submit proof all staff who assist with medications received medication training and licensee will provide statement for updated procedures regarding medication administration submit proof to CCLD by 10/24/25.
	8 9 10 11 12 13 14	Based on interviews and record review, the staff dispensed Client 1 (C1) bedtime medication at 4:40pm. C1 Physician Report states C1 is “unable to manage their medication”. Staff gave bedtime medication too early and C1 then went into the community, which posed a potential health and safety risk to client in care.	8 9 10 11 12 13 14
Type B 10/24/2025 Section Cited CCR 80078(a)	1 2 3 4 5 6 7	80078 Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee will provide a statement describing actions taken to provide additional care and supervision and will send statement to LPA via email by EOD 10/24/2025.
	8 9 10 11 12 13 14	Based on interviews and record review, the staff left Client 1 unattended in the community with bedtime medication in their system, intended to cause sleep which posed a potential health and safety risk to client in care.	8 9 10 11 12 13 14

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: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20250812142105

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: A CASA BLUE LAKE	FACILITY NUMBER: 425850568
	VISIT DATE: 09/25/2025

NARRATIVE

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Brief discussion with C1 while LPA and QAS were sitting at the dining table on 8/13/25, LPA noted that C1 was slurred in their words and could be unclear. C1 was able to carry on a conversation and even told a couple of jokes during this discussion, showing that while their speech may have been slurred, they were aware, awake, and able to communicate.

In reviewing the allegations, a prior Incident on 7/9/25 was noted by LPA where facility gave C1 their bedtime medication at 4:40 pm, one medication was Trazadone, one was Melatonin. Facility then took C1 to a community club meeting and left C1 without facility staff supervision. Before and during the meeting, per an interview with Witness 1 (W1), C1 was lethargic, unable to carry on conversations, and could not stay awake. W1 stated this was not normal behavior for C1 who usually participates in the meetings.

An incident report was submitted by the facility for this event, facility substantiated the medication was given early and provided the 4:40 pm notation on their report but claims that C1 asked for the medication early. Interview with administrator on 7/10/25, administrator stated the facility did not know that C1 had a meeting planned and that C1 asked for their bedtime medication early. LPA reminded administrator during initial conversation that C1’s Physician Report states that C1 is “unable to manage medications” therefore it is the responsibility of the facility staff.

During visit on 9/25/25 LPA confirmed that Trazadone order states “Take one tablet by mouth at bedtime.” The melatonin bottle which is a non-prescription medication states “Sleep Support” on the bottle. Despite the request of C1, staff cannot dispense medication against the doctor’s order and should not have left C1 unattended in the community knowing that C1 had medication intended to help C1 sleep.

Based on interviews and record reviews, the incident on 7/9/25 showed the facility did miss handle medication in giving a bedtime medication at 4:40 pm in the afternoon, 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).

Continued 9099-C page 2

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 29-AS-20250812142105

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: A CASA BLUE LAKE	FACILITY NUMBER: 425850568
	VISIT DATE: 09/25/2025

NARRATIVE

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On the allegation: Staff did not meet client's needs

It was alleged that C1 needed assistance ambulating back to C1’s room and that staff failed to provide this assistance. It is noted by W2 who has many years of experience supporting C1 in various homes, that a goal of the facility was to encourage C1 to walk. Review of Daily Progress Notes from 7/9/25 to 8/12/25 states that C1 walks to the dining room, restroom, C1’s bedroom, and sometimes outdoors. Interview with supportive W2 states that C1 has had many improvements while at the facility, one of which is being more ambulatory.

Daily progress notes speak to many daily activities that facility staff support C1 with. An interview on 9/24/25 with W2 reaffirmed that C1 is being supported by the facility, and they are attending to C1’s daily needs and activity requests. W2 has no concerns regarding staff not meeting C1’s needs.

In reviewing the allegations related to this complaint, it was noted that a prior incident occurred on 7/9/25, as detailed above. In that incident, the facility administered C1’s bedtime medication at approximately 4:40 p.m., after which C1 was taken to a community club meeting without facility staff supervision.

According to W1, when they contacted the facility to request that C1 be picked up, they were initially told to have C1 return via the regular transportation service (the Smooth Bus). However, the facility ultimately did pick up C1. The facility’s incident report states that C1 entered the facility van without appearing lethargic.

It remains unclear whether C1 was being deceptive or if W1’s account was entirely accurate. Nonetheless, the incident demonstrates that the facility failed to meet C1’s care and supervision needs by allowing C1 to attend a community event after administering a medication intended to induce sleep.

Based on interviews and record reviews, the incident on 7/9/25 showed the facility did fail to meet the client’s needs, 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).

Copy of report and appeal rights printed and given to the facility.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 6

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
08/12/2025 and conducted by Evaluator Melisa Rankin

COMPLAINT CONTROL NUMBER: 29-AS-20250812142105

FACILITY NAME:	A CASA BLUE LAKE		FACILITY NUMBER:	425850568
ADMINISTRATOR:	SORIANO, APRILYN A.		FACILITY TYPE:	735
ADDRESS:	1029 BLUE LAKE DRIVE		TELEPHONE:	(650) 544-1485
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY:	4	CENSUS: 4	DATE:	09/25/2025
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Aprilyn Soriano		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff violated personal rights

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

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

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 29-AS-20250812142105

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: A CASA BLUE LAKE	FACILITY NUMBER: 425850568
	VISIT DATE: 09/25/2025

NARRATIVE

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Interview done with the administrator on 8/13/25, states staff do not speak inappropriately to clients. The administrator stated that C1 has spoken obscene language to staff, but to the administrator’s knowledge staff have not violated C1’s rights. Interview done with W2 on 8/1/25 and again on 9/24/25, W2 has not heard and has not received reports from C1 that staff have violated C1’s personal rights.

Interview with staff on 9/25/25, they have not heard of another staff member or client using the word “stupid” in referring to anyone in the home. Staff stated clients will come home from program and talk about their day and activities, but staff interviewed stated the clients have been respectful to staff and they themselves nor other staff have been observed by them to speak inappropriately to clients.

Based on interviews. The allegations may have happened, but there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Copy of report printed for facility.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

LIC9099 (FAS) - (06/04)

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