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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802000
Report Date: 07/13/2026
Date Signed: 07/14/2026 08:08:22 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
02/27/2026 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20260227091233
FACILITY NAME:DREAM HAVEN OF SANTA PAULAFACILITY NUMBER:
565802000
ADMINISTRATOR:GRACE CATABAYFACILITY TYPE:
740
ADDRESS:404 E. MAIN STREETTELEPHONE:
(805) 420-9605
CITY:SANTA PAULASTATE: CAZIP CODE:
93060
CAPACITY:0CENSUS: 0DATE:
07/13/2026
UNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:Grace CatabayTIME COMPLETED:
05:20 PM
ALLEGATION(S):
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Staff are not properly trained.
INVESTIGATION FINDINGS:
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On 07/13/2026, Licensing Program Analyst (LPA), Esther Cortez contacted former Licensee Representative Grace Catabay to deliver findings for the above allegations telephonically as this facility closed as of 02/03/2026. A copy of this report will be emailed to the former licensee representative and mailed to the former licensee’s mailing address for signature.

On 02/27/2026, Community Care Licensing received a complaint against this closed facility. On 03/03/2026, Licensing Program Analyst (LPA), Esther Cortez contacted former Licensee Representative Grace Catabay to conduct an unannounced complaint investigation telephonically as this facility closed as of 02/03/2026 due to a Change of Ownership (CHOW). On 03/02/2026 and 03/11/2026, LPA Cortez arrived unannounced at the location of the closed facility to conduct a collateral investigation visits to address the allegations to this complaint. Location of the closed facility is the same facility location under a different Community Care Licensing (CCL) facility file number (565802454) which is currently open. Report will continue on LIC9099-C, 2ND PAGE,
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
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 6
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
02/27/2026 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20260227091233

FACILITY NAME:DREAM HAVEN OF SANTA PAULAFACILITY NUMBER:
565802000
ADMINISTRATOR:GRACE CATABAYFACILITY TYPE:
740
ADDRESS:404 E. MAIN STREETTELEPHONE:
(805) 420-9605
CITY:SANTA PAULASTATE:CAZIP CODE:
93060
CAPACITY:0CENSUS: 0DATE:
07/13/2026
UNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:TIME COMPLETED:
05:20 PM
ALLEGATION(S):
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9
Staff did not provide resident with a comfortable environment.
Staff did not address resident's change in condition.
INVESTIGATION FINDINGS:
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On 07/13/2026, Licensing Program Analyst (LPA), Esther Cortez contacted former Licensee Representative Grace Catabay to deliver findings for the above allegations telephonically as this facility closed as of 02/03/2026. A copy of this report will be emailed to the former licensee representative and mailed to the former licensee’s mailing address for signature.

On 02/27/2026, Community Care Licensing received a complaint against this closed facility. On 03/03/2026, Licensing Program Analyst (LPA), Esther Cortez contacted former Licensee Representative Grace Catabay to conduct an unannounced complaint investigation telephonically as this facility closed as of 02/03/2026 due to a Change of Ownership (CHOW). On 03/02/2026 and 03/11/2026, LPA Cortez arrived unannounced at the location of the closed facility to conduct a collateral investigation visit to address the allegations to this complaint. Location of the closed facility is the same facility location under a different Community Care Licensing (CCL) facility file number (565802454) which is currently open. Report will continue on LIC9099-C, 2ND PAGE,
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 29-AS-20260227091233
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: DREAM HAVEN OF SANTA PAULA
FACILITY NUMBER: 565802000
VISIT DATE: 07/13/2026
NARRATIVE
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On 03/02/2026, the LPA interviewed the Administrator, Assistant Administrator, conducted one phone interview with Witness 1 (W1), and obtained copies of resident records and other pertinent documents relevant to the investigation. On 03/11/2026, the LPA interviewed the Assistant Administrator, two (2) staff, conducted a resident file review, and obtained copies of resident records and other pertinent documents relevant to the investigation. On 03/12/2026, LPA conducted a phone interview with a hospice nurse.

On the allegation, “Staff are not properly trained” it is the concern of the reporting party (RP) that caregivers appeared inexperienced and insufficiently trained. It was further reported caregivers are not trained on how to contact hospice if needed. To investigate the complaint, the LPA conducted a file review and interviews. File review revealed that two (2) out of two (2) caregivers were missing nine (9) out of ten (10) hours of initial medication training. Interview with the administrator revealed that all of the staff training was in the files and a copy of the staff training was given to the LPA. Based on staff interviews and file review, there is sufficient evidence to support the allegation and that a violation occurred; therefore, the above allegation is deemed Substantiated at this time.

The following deficiency was cited from the CA Code of Regulations, Title 22 (refer to LIC 9099-D). A copy of the report and appeal rights will be emailed/mailed to the former Licensee.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20260227091233
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: DREAM HAVEN OF SANTA PAULA
FACILITY NUMBER: 565802000
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/20/2026
Section Cited
HSC
1569.69
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1569.69 Employees assisting residents with self-administration of medication: training requirements (a)(2)... shall complete 10 hours of initial training.. 6 hours of hands-on shadowing training, .. and 4 hours of other training or instruction.. This requirement is not met as evidence by:
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Facility is now closed. POC is cleared.
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Based on record review and staff interviews the Licensee did not comply with the regulation cited above as staff was missing 9 hours of medication training which possess a potential health, safety and personal rights 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.
SUPERVISOR'S NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 29-AS-20260227091233
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: DREAM HAVEN OF SANTA PAULA
FACILITY NUMBER: 565802000
VISIT DATE: 07/13/2026
NARRATIVE
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On 03/02/2026, the LPA interviewed the Administrator, Assistant Administrator, conducted one phone interview with Witness 1 (W1), and obtained copies of resident records and other pertinent documents relevant to the investigation. On 03/11/2026, the LPA interviewed the Assistant Administrator, two (2) staff, conducted a resident file review, and obtained copies of resident records and other pertinent documents relevant to the investigation.

Regarding the allegation, “Staff did not provide resident with a comfortable environment” it is the concern of the Reporting Party (RP) that Resident 1’s (R1’s) room was reported to be approximately 60 degrees in October or November of 2025 and the Licensee provided a portable heater without a thermostat, and the family later provided a heater with a thermostat. It was further reported that on 12/29/2025 it was reported that the room temperature was 72 degrees and the resident was covered with several blankets and the resident’s skin felt “slimy”. During all the LPA’s visits the facility had a comfortable temperature ranging from 70 degrees Fahrenheit to 72 degrees Fahrenheit and the facility had an AC unit and a heater. Staff do not recall the room being at 60 degrees and revealed that there was a situation where two of R1’s daughters would often complain about the temperature in R1’s room and would always change it. The staff would try to maintain the temperature within regulations, usually at 72 degrees, depending on the weather. One daughter complained that it was too hot, and the other that it was too cold and would often change the temperature in the room. Furthermore, it was revealed that there was one instance where one of R1’s daughter arrived to visit R1and both the portable heater and the facility heater were both on and the resident had blankets. Staff denied turning on the heaters and said that another daughter had visited R1 prior. As soon as they were notified, they turned off the heaters and took off the blankets from R1. It was unknown who had turned on the heaters and staff revealed that they often check on the residents and if they notice the rooms too hot, they will turn on the AC or if they notice it too cold, they will put blankets on the residents or turn on the heater and make sure they are comfortable. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation occurred, therefore this allegation is deemed Unsubstantiated at this time.

Report will continue on LIC9099-C, 3RD page.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 29-AS-20260227091233
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: DREAM HAVEN OF SANTA PAULA
FACILITY NUMBER: 565802000
VISIT DATE: 07/13/2026
NARRATIVE
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On the allegation, “Staff did not address resident's change in condition” it is the concern of the reporting party (RP) that staff did not adequately monitor Resident 1 (R1) or follow hospice nurse instructions regarding R1's care. It was reported that in early 2026 (exact date was not provided), a hospice nurse identified that R1 was constipated and instructed staff to notify the on-call nurse if no bowel movement (BM) occurred by the following day. Staff reportedly failed to provide this update. Family members later discovered R1 feverish, shaking, with cloudy fluid in their Foley bag and noted that R1 had not had a BM in seven days. The family, rather than staff, contacted the on-call nurse. To investigate the allegation, the LPA conducted telephonic and in-person interviews, as well as record reviews of facility records.

Interview with former Designee Abygail Go revealed that staff monitored R1’s condition and documented BMs. She noted that hospice instructions were to call after three days without a BM, though she admitted staff occasionally waited until the fourth day if a nurse visit was already scheduled or if R1 had a BM at night. Staff interviews revealed inconsistent protocols; while one staff member confirmed reporting to the Administrator and not hospice, another was unaware of who was responsible for BM tracking. During a telephone interview, Hospice Nurse 1 (HP1) confirmed that staff were verbally instructed to call after R1 had not had a BM after three (3) days and noted that while staff generally followed it, there was at least one instance where they waited five days to call (did not provide date). HP1 doubted R1 ever went seven days without a BM. Facility BM logs for January and February 2026 contradict the seven-day claim but confirm inconsistencies in care. Logs show that in February, R1 went four consecutive days without a BM on two separate occasions (2/6–2/9 and 2/13–2/16), exceeding the three-day limit set by hospice.

A review of facility administrative records determined that this facility underwent a change of ownership, and the previous licensee closed operations on February 3, 2026. The documented instances where R1 went four consecutive days without a BM occurred entirely after the facility closure and change of ownership date. These specific compliance discrepancies fell under the operational scope of the new management and have already been investigated and cited under report number 29-AS-20260226100507. Because the substantiated regulatory failures occurred under the authority of the new licensee, there is insufficient evidence to confirm that a violation occurred under the previous licensee's period of operation. Therefore, the allegation is deemed unsubstantiated at this time.

A copy of the report will be emailed/mailed to the former Licensee.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6