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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801259
Report Date: 07/15/2025
Date Signed: 07/15/2025 02:50:28 PM

Unsubstantiated


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
11/13/2024 and conducted by Evaluator Emily Peraldi
COMPLAINT CONTROL NUMBER: 29-AS-20241113132921
FACILITY NAME:MG2 FAMILY HOMEFACILITY NUMBER:
565801259
ADMINISTRATOR:MARIA MIRANDAFACILITY TYPE:
735
ADDRESS:5031 HALSEY WAYTELEPHONE:
(805) 488-6527
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:6CENSUS: 6DATE:
07/15/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Maria MirandaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Licensee is not addressing pests at the facility.
Staff is not distributing a resident's medication as prescribed.
Staff are not ensuring that residents are provided with activities while in care.
Staff falsified records.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Emily Peraldi and Angela Barutyan conducted an unannounced subsequent complaint visit to this facility. At 10:35 a.m., the LPAs arrived at the facility and called Administrator, Maria Miranda and explained the reason for the visit. At 10:48 a.m., the Administrator arrived at the facility.

During the initial visit conducted on 11/19/2024 between 10:30 a.m. and 2:00 p.m., the LPA conducted a physical plant tour and interviews with the Administrator, two (2) staff and one (1) client. During the initial visit, the LPA conducted a review of medication and medication documentation with the Administrator for all six (6) clients. During today’s visit, starting at 10:56 a.m., the LPAs conducted a physical plant tour. Between 11:32 a.m. and 2:28 p.m., the LPAs conducted interviews with the Administrator, three (3) staff and four (4) clients. At 11:19 a.m., the LPAs conducted a review of medication and medication documentation with the Administrator for two (2) out of six (6) clients. During both visits, the LPA requested and obtained copies of pertinent documents. Continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
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-20241113132921
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: MG2 FAMILY HOME
FACILITY NUMBER: 565801259
VISIT DATE: 07/15/2025
NARRATIVE
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Regarding the allegation: 1.) Licensee is not addressing pests at the facility. The Department received a complaint alleging that the facility had a cockroach infestation and that the Licensee did not address it. During the initial complaint visit, the LPA conducted a physical plant tour and did not observe cockroaches at the facility. During today’s visit, the LPAs conducted a physical plant tour and inspected kitchen drawers, common areas and bedrooms. The LPAs did not observe any cockroaches or pests. An interview with the Administrator revealed that a pest control company does monthly pest treatment inside and outside of the facility. The Administrator provided the LPAs with the most recent invoice dated 07/08/2025. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

2.) Staff is not distributing a resident's medication as prescribed. It was alleged that staff would not properly assist Client #1 (C1) with their self-administration of Magnesium medication and would throw away missed medications. During the initial visit and subsequent visit, the LPA conducted a review of medication and medication documentation and observed that medications were properly documented and assisted as prescribed. Additionally staff interviews denied the allegation of disposing of C1’s Magnesium medication. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

3.) Staff are not ensuring that residents are provided with activities while in care. It was alleged that when staff take clients on outings, staff leave clients in the vehicle while staff go shopping for themselves. Interviews conducted with staff denied the allegation. Interview with the Administrator revealed that staff on the weekdays and weekends take clients to go shopping, to go out to eat or to the beach. The Administrator explained that each client enjoys a variety of leisure activities including listening to music and walking around the neighborhood. Additionally, the LPAs observed recent pictures of clients at the beach and at community events and Administrator provided information of future planned outings. Interviews with clients did not note any concerns. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. Continued on LIC 809-C.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20241113132921
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: MG2 FAMILY HOME
FACILITY NUMBER: 565801259
VISIT DATE: 07/15/2025
NARRATIVE
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4.) Staff falsified records. It was alleged that staff falsified records such as temperature logs. Interviews conducted with the Administrator and staff did not support the allegations. Furthermore, LPAs reviewed records and did not observe any markings or other indicators of documents being altered/falsified. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3