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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 561702356
Report Date: 12/05/2025
Date Signed: 12/05/2025 01:01:23 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
12/01/2025 and conducted by Evaluator Emily Peraldi
COMPLAINT CONTROL NUMBER: 29-AS-20251201113735
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: 22DATE:
12/05/2025
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Romeo Sapida, facility staffTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Facility staff do not keep residents’ rooms free from bed bugs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Emily Peraldi conducted an unannounced initial complaint visit to this facility. At 10:40 a.m., the LPA met with staff and explained the reason for the visit. At 10:50 a.m., the LPA spoke with the Administrator, Floro Cortes Jr via telephone call as he was unavailable to meet the LPA during today's visit

During today’s visit between 10:45 a.m. and 11:30 a.m., the LPA conducted interviews with eight (8) clients and two (2) staff. Starting at 11:07 a.m., the LPA along with staff conducted a physical plant tour. The LPA also requested copies of pertinent documents during the visit.


Continued on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2025
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 4
Control Number 29-AS-20251201113735
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: 12/05/2025
NARRATIVE
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Regarding the allegation: Facility staff do not keep residents’ rooms free from bed bugs. On 12/01/2025, the Department received a complaint alleging that client rooms had bed bugs. Interviews conducted with the Administrator and staff revealed bedbugs were observed in two (2) rooms. The Administrator explained that once he was made aware of the bed bugs, he contacted Dash Pest Control company. The Administrator stated that Dash Pest Control conducts monthly pest control services for all the buildings at the facility. The Administrator explained that starting on December 1st and December 2nd, Dash Pest Control started treating each building for bed bugs. The Administrator explained that the clients affected received new mattresses and cleaned bed sheets. During today’s visit, the LPA observed Dash Pest Control treating the main building for bed bugs. Interviews with staff reported that when cleaning rooms, they also inspect for bed bug activity. Additionally, during today’s visit the LPA observed Client #1 (C1) with bed bug bites on C1’s hands. Based on the information provided by interviews, observations and record review, the preponderance of evidence standard has been met, therefore the above allegation is deemed Substantiated at this time.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D).

Exit interview conducted. The Administrator authorized staff Romeo Sapida to sign the report. A copy of the report and appeal rights were provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20251201113735
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: 12/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/06/2025
Section Cited
CCR
80087(a)(1)
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80087 (a)(1) Buildings and Grounds
(a) The facility shall be clean...at all times for the safety and well-being of clients...(1) The licensee shall take measures to keep the facility free... other insects.This requirement is not met as evidenced by:
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The Administrator contacted a pest control company to start treating for bed bugs.
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Based on interviews, observations and record review, the licensee failed to comply with the section cited above as bed bugs were observed in two (2) client rooms which poses an immediate health and safety 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: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4