565802410-3-14-2025-29-AS-KBUY-DF7PH2-20250328111914

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802410
Report Date: 03/13/2025
Date Signed: 03/14/2025 08:52:35 AM

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
05/01/2024 and conducted by Evaluator Teresa Camara

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20240501135228

FACILITY NAME:	PEOPLE'S CARE GOODENOUGH		FACILITY NUMBER:	565802410
ADMINISTRATOR:	DANIELA MOSQUERA		FACILITY TYPE:	735
ADDRESS:	2591 GOODENOUGH RD		TELEPHONE:	(805) 524-5617
CITY:	FILLMORE	STATE: CA	ZIP CODE:	93015
CAPACITY:	6	CENSUS: 5	DATE:	03/13/2025
		UNANNOUNCED	TIME BEGAN:	03:25 PM
MET WITH:	Rudi Otani		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff hit a client resulting in multiple injuries

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint visit to deliver findings for the above allegation. LPA met with house manager Rudi Otani and explained the reason for the visit. The administrator Daniela Mosqueda was not at the facility.

On 05/01/2024, the Department received a complaint regarding allegations of physical abuse by Staff #1 (S1). It was alleged that S1 hit Client #1 (C1) on their legs for asking for cigarettes.

(continued on LIC9099-C, page 2)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

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-20240501135228

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: PEOPLE'S CARE GOODENOUGH	FACILITY NUMBER: 565802410
	VISIT DATE: 03/13/2025

NARRATIVE

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(continued from LIC9099, page 1)

On 05/02/2024, LPA and Tri-Counties Regional Center Quality Assurance Specialist (QAS) Liz Aced-Arnett conducted an initial visit to the facility. At approximately 9:43 a.m. LPA and QAS met with administrator Daniella Mosqueda. The administrator stated C1 stays on the crisis side of this facility and is assigned a one to one (1:1) staff 24 hours a day. C1 goes through cycles of behaviors and will target certain staff. Currently, C1 is targeting S1. C1 also has a history of self-injurious behavior where C1 will hit themselves and kick things, causing bruising and other injuries. C1 smokes cigarettes and staff must keep C1 on a schedule for smoke breaks to ensure C1 does not run out before C1 gets money to purchase more cigarettes. Limiting the cigarettes can sometimes lead to behaviors.

The administrator stated S1 works on the weekends, usually during the p.m. and NOC (night) shift. The administrator tries to schedule S1 to work on the permanent side of the facility rather than the crisis side to avoid conflict with C1 as C1 has a history of calling the police and making false allegations against S1. Sometimes due to staffing shortages, S1 will have to work on the crisis side of the facility. The administrator stated she has not received any complaints or concerns from other staff or clients. Nobody has witnessed any of the abuse allegations C1 has made against S1.

On 05/02/2024, LPA and QAS met with C1 at approximately 10:42 a.m. while C1 was seated on the back patio smoking a cigarette. LPA observed some discoloration on C1’s abdomen and legs. C1 stated S1 hit them on their legs. C1 stated S1 withholds their cigarettes. C1 told LPA and QAS they threw hot water at S1 for withholding their cigarettes. C1 told LPA and QAS they want S1 fired and taken out of the facility.

On 05/14/2024, LPA and QAS conducted telephone conference interviews with S1 at 2:02 p.m., Staff #2 (S2) at 2:24 p.m., and Staff #3 (S3) at 10:05 a.m.

(continued on LIC9099-C, page 3)

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20240501135228

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: PEOPLE'S CARE GOODENOUGH	FACILITY NUMBER: 565802410
	VISIT DATE: 03/13/2025

NARRATIVE

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(continued from LIC9099-C, page 2)

S1 stated they work at the facility on the weekends. S1 works sometimes 6:00 a.m. to 10:00 p.m. and works NOC shift. S1 stated C1 is addicted to cigarettes, and they must keep C1 on a schedule so C1 doesn’t smoke them all at once. If C1 is having a bad day, limiting C1’s cigarettes can cause behaviors. S1 said C1 is a nice person but goes through behavior cycles. S1 denied ever putting C1 in a CPI hold, hitting, kicking or withholding food from C1. S1 stated C1 has thrown items at S1 including hot water, a radio and a television. S1 runs away from C1 to avoid injury and then talks to C1 to de-escalate. The administrator tries to schedule S1 on the permanent side of the facility to avoid S1 working with C1 but sometimes due to staffing issues, S1 must work on the crisis side.

S2 stated they have never witnessed anything questionable go on between C1 and S1. S2 has never witnessed any staff mistreat C1. S2 was present at the facility on 01/28/2024, when C1 called the police alleging S1 abused them. On that evening, S2 saw S1 go outside to move their car. While S1 was outside, C1 asked S2 for the phone and requested privacy. S2 then heard C1 on the phone (with 9-1-1) saying, “Don’t hit me! Owe! Somebody is beating me up! Owe! Come help me!” However, there was nobody in the room with C1. S2 thinks C1 calls for the police so they can leave the facility and go to the hospital. In addition, C1 has made the same type of false allegations against S2 in the past. C1 will also refuse to eat and then later make allegations that staff withheld food.

S3 stated they have never witnessed any abuse by S1. C1 has a history of making false allegations against staff. C1 does not like S1, and the administrator tries to schedule S1 on the other side of the facility to avoid S1 working near C1. S3 recalled one day C1 alleged S1 kicked her in the face but S1 was never around C1 on that day. S3 stated C1 does not like to talk with the other clients and prefers to stay on the crisis side. S3 will try to get C1 to go to the permanent side where the large kitchen is located so they could cook together but C1 does not like to leave the crisis side. C1 will mostly stay outside on the patio and smoke cigarettes.

(continued on LIC9099-C, page 4)

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20240501135228

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: PEOPLE'S CARE GOODENOUGH	FACILITY NUMBER: 565802410
	VISIT DATE: 03/13/2025

NARRATIVE

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(continued from LIC9099-C, page 3)

On 3/4/2025, LPA conducted a subsequent visit to the facility. All clients were at day program. LPA was informed that on 11/6/2024, C1 was transferred to a facility that could provide a higher level of care as C1’s health needs had increased. LPA conducted interviews with the administrator, facility nurse, house manager and staff starting at 12:37 p.m. None of the staff interviewed had ever witnessed any staff be physically abusive or rough with C1, or any other client. All of the staff stated they had witnessed C1 conduct self-harm, including hitting their own stomach, legs, ankles, feet, kicking doors and walls, hitting doors and walls. Staff stated C1 bruises easily. Staff stated C1 would also attack staff by hitting them and throwing items at them. Staff would run away from C1 and use their voices to calm C1 down and understand C1’s needs during the behavioral events.

On 3/13/2025, LPA conducted a visit to a day program to interview two clients. Neither client ever witnessed or experienced abuse by staff. Both clients stated they witnessed C1 throw themselves on the ground. On 3/13/2025, LPA conducted interviews at the facility with two other clients who also stated they never witnessed staff abuse C1, nor have they experienced abuse themselves.

Based on the interviews, C1 was observed making false allegations against S1 during a 9-1-1 call. C1 claimed on the call that S1 was abusing them but S1 wasn’t even inside the facility or near C1 when the allegation was made. Nor was S1 working with C1 on that day, 01/28/2024. In addition, staff denied ever witnessing any abuse of C1 by any staff, including S1. However, staff stated they had witnessed C1 conduct self-injurious behaviors such as hitting themselves and kicking at walls/doors causing bruising. None of the other clients at the facility witnessed or experienced abuse by any staff. Therefore, the allegation staff physically abused resident which resulted in an injury is deemed Unsubstantiated at this time.

No deficiencies observed. Exit interview conducted and report issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC9099 (FAS) - (06/04)

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