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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 561702356
Report Date: 12/20/2024
Date Signed: 12/20/2024 02:50:40 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
12/19/2024 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20241219133618
FACILITY NAME:COTTONWOOD, THEFACILITY NUMBER:
561702356
ADMINISTRATOR:FLORO P CORTES JRFACILITY TYPE:
735
ADDRESS:1417 LIRIO AVENUETELEPHONE:
(805) 647-6046
CITY:SATICOYSTATE: CAZIP CODE:
93004
CAPACITY:24CENSUS: 21DATE:
12/20/2024
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Floro Cortes Jr.TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility bathroom is in disrepair
Resident's behavior poses a risk to other residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Teresa Camara conducted a complaint investigation visit. LPA met with licensee/administrator Floro Cortes, Jr. and explained the reason for the visit.

At 10:50 a.m. LPA interviewed staff, at 11:15 a.m. LPA interviewed licensee, at 1:03 p.m. LPA interviewed client 1 (C1) and client 2 (C2), at 1:12 p.m. LPA inspected the room belonging to C1 and C2. At 1:22 p.m. LPA inspected the facility's food supply and menu.

LPA inspected the bathroom belonging to C1 and C2. There is a hole in the plaster behind the toilet. Licensee stated they had to access plumbing at one time and the hole is covered with a sheet of wood. The hole does not go all the way to the outside, it is only in the plaster which is covered by a board at this time.

(continued on LIC9099-C, page 2)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
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 5
Control Number 29-AS-20241219133618
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: COTTONWOOD, THE
FACILITY NUMBER: 561702356
VISIT DATE: 12/20/2024
NARRATIVE
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(continued from LIC9099, page 1)

Licensee stated the facility received a grant to complete necessary repairs. He still has to confirm the scope of repairs covered by the grant. He had put the bathrooms on the list of needed repairs but is not sure if there will be enough money with the grant to repair/remodel all bathrooms. Based on this information, the allegation the facility bathroom is in disrepair is deemed Substantiated at this time.

LPA interviewed staff who confirmed they have witnessed C2 smoke methamphetamine in their room. When they discover this going on they tell the client to stop. Licensee stated they have called the police on clients doing illegal drugs in the facility but they don't arrest them, they just give them a citation. Licensee stated confronting some of these clients, especially those who gather together to do drugs, can be dangerous. It triggers their behaviors and they become aggressive. LPA inquired if the licensee has contacted the clients' POAs and physicians. Licensee stated staff let the POAs, who are usually Ventura County Behavioral Health caseworkers, because they are the people who take the clients to their doctors. LPA informed licensee he should be contacting the doctor himself. If staff feel there is a danger confronting clients regarding their illegal drug use they should call the police and write up an incident report. Based on this information, the allegation resident's behavior poses a risk to other residents in care, is deemed Substantiated at this time.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

Exit interview was conducted. Today's report and appeal rights were reviewed with administrator and a copy of the report was provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20241219133618
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: COTTONWOOD, THE
FACILITY NUMBER: 561702356
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/27/2024
Section Cited
CCR
80087(a)
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80087 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 was not met as evidenced by:
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Licensee will confirm with his contractor that bathroom repairs/remodel is part of the scope of repairs covered by the grant and relay this information to CCL by 12/27/2024.
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Based on interviews and observations, the licensee did not comply with the above cited section, the bathroom for C1 and C2 was observed to be in disrepair, which poses a potential health and safety risk to residents in care.
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Type B
12/27/2024
Section Cited
CCR
80072(a)(2)
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80072 Personal Rights (a) ... each client shall have personal rights which include, but are not limited to, the following: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Licensee will train staff by 12/27/2024, the following: Submit an incident report and note on the report that the POA, caseworker and physician were notified. If staff feel the drug use or resulting behavior is a threat to others, they will also call the police.
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This requirement was not met as evidenced by: Based on interviews, the licensee did not comply with the above cited section, C2 has been seen doing drugs in the room they share with C1, which poses a potential health and safety risk to residents 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: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
12/19/2024 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20241219133618

FACILITY NAME:COTTONWOOD, THEFACILITY NUMBER:
561702356
ADMINISTRATOR:FLORO P CORTES JRFACILITY TYPE:
735
ADDRESS:1417 LIRIO AVENUETELEPHONE:
(805) 647-6046
CITY:SATICOYSTATE: CAZIP CODE:
93004
CAPACITY:24CENSUS: 21DATE:
12/20/2024
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Floro Cortes, Jr.TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Residents are not served good quality foods
Resident's shower is unsanitary
Staff did not provide adequate laundry services to residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Teresa Camara conducted a complaint investigation visit. LPA met with licensee/administrator Floro Cortes, Jr. and explained the reason for the visit.

At 10:50 a.m. LPA interviewed staff, at 11:15 a.m. LPA interviewed licensee, at 1:03 p.m. LPA interviewed client 1 (C1) and client 2 (C2), at 1:12 p.m. LPA inspected the room belonging to C1 and C2. At 1:22 p.m. LPA inspected the facility's food supply and menu.

LPA inspected the food supply and menu, the food appeared to be of good quality with plenty of fresh meats and vegetables as well as a supply of non-perishable food. The menu reflected foods all clients would be able to eat, even if the clients were to have dental issues as most of the items are soft. Staff stated that if they serve hard cookies for snacks they are always served with coffee or juice that clients could use to soften
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20241219133618
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: COTTONWOOD, THE
FACILITY NUMBER: 561702356
VISIT DATE: 12/20/2024
NARRATIVE
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(continued from LIC9099A, page 4)

cookies. Based on observation, the allegation the food served is not of good quality is deemed Unsubstantiated at this time.

LPA inspected the shower/tub combination in the bathroom belonging to C1 and C2. The tub appeared clean. LPA interviewed staff who confirmed C2 sometimes has urinary and/or bowel incontinence in the shower. Staff will clean it up using a bleach mixture to sanitize the tub. Based on observation and interviews, the allegation resident's shower is unsanitary is deemed Unsubstantiated at this time.

LPA inspected the room of C1 and C2. It was reported that the laundry is returned to clients damp and the room smelled like mold. LPA did not notice any mold or mildew smell in the room. LPA interviewed clients who denied receiving damp laundry back from staff. LPA interviewed staff who stated they never return damp laundry to clients. They have two large dryers. Some clients prefer to do their own laundry, otherwise staff do the laundry and return it to clients. Staff will help clients fold the laundry and put it away if they request assistance. Otherwise, clients will fold their own laundry and put it away as it gives them something to do. Staff stated large bedding items like blankets or quilts are hung on the laundry line to dry in the sun. Sometimes C2 will remove their blanket from the line before it is completely dry. They have asked C2 not to do that as it will be cold for them later and possibly cause them to be sick but C2 still sometimes does that. Based on this information, the allegation staff did not provide adequate laundry services to residents in care is deemed Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted and report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5