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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801423
Report Date: 04/09/2025
Date Signed: 04/09/2025 03:36:53 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/04/2025 and conducted by Evaluator Martha Arroyo
COMPLAINT CONTROL NUMBER: 29-AS-20250404131959
FACILITY NAME:HOUSE OF TRANSITIONFACILITY NUMBER:
565801423
ADMINISTRATOR:TIFFANY CURTISFACILITY TYPE:
772
ADDRESS:1750C SOUTH LEWIS ROADTELEPHONE:
(805) 437-2903
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY:15CENSUS: 15DATE:
04/09/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Francine Figueroa TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff are retaining a resident that requires a higher level of care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Martha Arroyo conducted an initial complaint investigation visit for the above allegation. Upon arrival, the LPA met with Residential Program Manager, Francine Figueroa and explained the reason for the visit. The Clinical Director, Tiffany Curtis arrived shortly after. Entrance interview conducted.

During today's visit, the LPA conducted interviews with three staff starting at 9:55AM, conducted a client file review at 10:30AM and obtained copies of pertinent documents relevant to the investigation.

Report Continued on LIC 9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
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-20250404131959
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: HOUSE OF TRANSITION
FACILITY NUMBER: 565801423
VISIT DATE: 04/09/2025
NARRATIVE
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Report Continued from LIC 9099C...

It was alleged that staff are retaining a resident who requires a higher level of care. The complainant is concerned that facility staff are unable to properly care for Client #1 (C1). A review of C1’s Physician Report dated 12/04/2024 indicates that C1’s primary diagnosis is major depressive disorder, with no secondary diagnosis. Additionally, according to the updated Needs & Service Plan dated 03/07/2025, there is no mention of C1’s recurring incidents or how the facility staff will ensure proper care is provided to C1 during such incidents. Similarly, no records were found in C1’s file indicating a diagnosis of seizures or seizure-like symptoms. Interviews conducted with staff revealed that the facility is aware of C1’s need for a higher level of care due to their medical episodes resulting in facility staff calling medical emergency to ensure C1's safety and proper care. Based on the information obtained and reviewed, the Department has sufficient evidence to say, “staff are retaining a resident who requires a higher level of care”. Therefore, this allegation is being deemed Substantiated at this time.

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. A copy of the report and appeal rights were provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20250404131959
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HOUSE OF TRANSITION
FACILITY NUMBER: 565801423
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/18/2025
Section Cited
CCR
81068.4(a)(4)
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81068.4 (a)(4) The licensee shall not admit or retain the following: Persons who require more care and supervision…

This requirement is not met as evidenced by:
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The Licensee issued a 30-day eviction notice to the client on April 10, 2025, and will continue to report the client’s medical episodes and coordinate with VCBH to identify a suitable placement that meets the client’s medical needs.
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Based on record review and interviews, the licensee did not comply with the section cited above as C1 requires a higher level of care due to their recent medical episodes, which poses an immediate health and safety concern to persons in care.
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The Plan of Correction has been amended to appropriately address the identified deficiency.
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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: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3