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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801434
Report Date: 05/21/2025
Date Signed: 05/21/2025 11:03:04 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
05/22/2024 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20240522105627
FACILITY NAME:STARSHIPFACILITY NUMBER:
565801434
ADMINISTRATOR:JORDAN WARDFACILITY TYPE:
772
ADDRESS:1760 SOUTH LEWIS ROADTELEPHONE:
(805) 383-3669
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY:15CENSUS: 15DATE:
05/21/2025
UNANNOUNCEDTIME BEGAN:
10:49 AM
MET WITH:Chuck HillTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Resident is not being provided care
Staff yelled at resident in care
Staff did not safeguard resident's personal property
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced follow-up complaint investigation visit at the facility at 10:49 AM. LPA met with Regional Director of Operations Chuck Hill (RDO) the reason for the visit was explained and entrance interview was conducted.

During the initial complaint visit on 05/30/2024 LPA Teresa Camara conducted interviews with staff and client 1 (C1) between 10:15 AM and 1:55 PM LPA Camara reviewed documents starting at 3:30 PM. During a follow-up visit on 04/01/2025 LPA Byrne conducted a brief physical plant tour and interviewed three (3) staff members and one (1) Client between 11:15 AM and 12:20 PM. During a visit on 05/14/2025 between 11:00 AM and 03:15 PM LPA Byrne reviewed one (1) resident file, collected copies of pertinent documentation, interviewed one (1) staff and attempted to interview two (2) witnesses. During today’s visit LPA delivered findings for three (3) allegations.
Continued on LIC 9099C.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
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 5
Control Number 29-AS-20240522105627
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: STARSHIP
FACILITY NUMBER: 565801434
VISIT DATE: 05/21/2025
NARRATIVE
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The allegation of “Staff did not safeguard resident's personal property” alleges that client #1 (C1)’s personal property was thrown away by facility staff without C1’s consent. Interviews with C1 revealed that on April 26, 2024, C1 had left their bag with two packs of cigarettes at the facility prior to leaving the facility to spend time with an acquaintance. C1 stated that once they returned to the facility on April 28th, they were advised that their cigarettes were thrown away by staff. LPA interviewed Staff #1 (S1) who confirmed that they had found a resident’s bag containing Camel cigarettes stored in the office. S1 stated that they and other facility staff attempted to identify the owner of the bag, but no client claimed the items. LPA interviewed witness #1 (W1) who stated that after no residents claimed the items, they were instructed by S1 to throw the bag out. W1 stated that this made them uncomfortable as it is out of the ordinary for staff to throw out the personal items of clients. Interviews with multiple staff members confirmed that it is not normal for the facility to throw away client’s personal items. Interviews with staff #2 (S2) confirmed that client’s personal items have been held in the office for up to thirty (30) days without being thrown away. Interviews with both S1 and C1 confirmed that C1’s cigarettes were replaced after the incident. Based on the information obtained during interviews there is sufficient evidence to support the allegation of “Staff did not safeguard resident's personal property.” Therefore, the allegation is deemed Substantiated at this time.

The allegation of “Staff yelled at resident in care” alleges that S1 yelled at C1 during a meeting to discuss C1’s missing personal belongings. LPA Camara interviewed C1 who stated that while confronting S1 about the missing items S1 raised their voice at R1 and ended the confrontation by slamming the office door on them. LPA Byrne interviewed W1 who witnessed the confrontation. W1 confirmed that S1 yelled at C1 during the confrontation and slammed the door on C1 “With full force”. LPA interviewed S1 who confirmed that they had a confrontation with C1 over the missing items but denied raising their voice at C1. LPA interviewed a current client, client #2 (C2). The interview with C2 did not reveal any concerns with staff raising their voices at clients. C2 denied staff ever yelling at them. Based on the information obtained during interviews there is sufficient evidence to support the allegation of “Staff yelled at resident in care.” Therefore, the allegation is deemed Substantiated at this time.

Continued on LIC 9099C.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20240522105627
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: STARSHIP
FACILITY NUMBER: 565801434
VISIT DATE: 05/21/2025
NARRATIVE
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The allegation of “Resident is not being provided care” alleges that C1 was not being provided with an appropriate level of care while they resided at the facility. Interviews with staff #3 (S3) and RDO revealed that the program C1 was enrolled in provides clients with stable housing, access to hygiene products, mandatory visits to a Ventura County Behavioral Health (VCBH) Psychiatrist, 60-day progress review, and access to therapy resources. LPA Camara interviewed C1 who raised concerns about the quality of care they were receiving through their Psychiatrist who is a VCBH employee and is not employed by the facility. C1 stated that they were not receiving their 60-day progress reviews as required by the program. Interviews with facility staff also revealed concerns that C1 was not receiving 60-day progress reviews. LPA reviewed C1’s resident file. LPA observed C1 to be admitted to the facility in June 2023. LPA observed 60-day progress notes for August 2023, October 2023, and December 2023. LPA observed C1’s discharge date to be in July 2024. LPA confirmed that C1 had no 60-day progress reviews for the year of 2024. Based on the information obtained during interviews there is sufficient evidence to support the allegation of “Resident is not being provided care.” Therefore, the allegation is deemed Substantiated at this time.

The following deficiencies were cited (refer to LIC 9099D). A copy of the report was printed, appeal rights were provided, and exit interview was conducted.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20240522105627
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: STARSHIP
FACILITY NUMBER: 565801434
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/14/2025
Section Cited
CCR
81078(a)
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81078 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:
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LPA obtained proof of corrections on 04/14/2025 as part of the amended report. POC cleared.
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Based on interview and record review the licensee did not comply with the section cited above as C1 was not receiving 60-day progress reports that were provided to other clients enrolled in the same program which poses a potential personal rights risk to clients in care.
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Type B
04/14/2025
Section Cited
CCR
81072(a)(1)
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81072 Personal Rights
(a) Each client shall have personal rights which include, but are not limited to, the following:
(1) To be accorded dignity in his/her personal relationships with staff and other persons.
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LPA obtained proof of corrections on 04/14/2025 as part of the amended report. POC cleared.
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Based on interview the licensee did not comply with the section cited above as S1 yelled at and slammed a door on C1 while the client was under their care which poses a potential personal rights risk to clients 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: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20240522105627
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: STARSHIP
FACILITY NUMBER: 565801434
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/14/2025
Section Cited
CCR
81026(b)
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81026 Safeguards for Cash Resources Personal Property and Valuables
(b) If such a client is admitted... his/her ...personal property... shall be safeguarded...
This requirement is not met as evidenced by:
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LPA obtained proof of corrections on 04/14/2025 as part of the amended report. POC cleared.
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Based on interview the licensee did not comply with the section cited above as C1's personal belongings were not appropriately safeguarded while C1 was out of the facility which poses a potential personal rights risk to clients 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: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5