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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802451
Report Date: 04/10/2025
Date Signed: 04/10/2025 11:53:46 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
04/04/2025 and conducted by Evaluator Emily Peraldi
COMPLAINT CONTROL NUMBER: 29-AS-20250404121125
FACILITY NAME:PHOENIX8-1,LINCOLNFACILITY NUMBER:
565802451
ADMINISTRATOR:SUSANA L. MIXFACILITY TYPE:
735
ADDRESS:1900 LINCOLN CTTELEPHONE:
(805) 488-3923
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:9CENSUS: 6DATE:
04/10/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Rosemarie SironTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff will not allow client to be readmitted to the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced initial complaint visit to this facility. At 10:00 a.m., the LPA met with staff and explained the reason for the visit. At 10:48 a.m., the LPA spoke with Gerard Gonzalez; he authorized staff Rosemarie Siron to sign the report.

Between 10:03 a.m. and 10:48 a.m., the LPA conducted interviews with two (2) staff and one (1) client. At 10:06 a.m., the LPA along with staff conducted a physical plant tour. At 10:08 a.m., the LPA obtained copies of the LIC 500 and LIC 9020.

Continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
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 2
Control Number 29-AS-20250404121125
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: PHOENIX8-1,LINCOLN
FACILITY NUMBER: 565802451
VISIT DATE: 04/10/2025
NARRATIVE
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Regarding the allegation: Staff will not allow client to be readmitted to the facility. It was alleged that the Administrator is refusing the return of Client #1 (C1) from the hospital. LPA Peraldi conducted a file review on 04/07/2025 and the following was noted: Per incident reported dated 04/06/2025, C1 was having disruptive behaviors and unauthorized absence on 04/03/2025. On the same day, C1 had another unauthorized absence and continued disruptive behaviors at night; 911 was called and C1 was hospitalized and was put on a 5150 hold. Telephone call with Administrator, Susana Mix on 04/04/2025, revealed that C1 was discharged on Friday, 04/04/2025 and a Lyft car ride was set up to pick up C1 from the hospital and to be taken back to the facility. The Administrator stated that she was aware that they needed to accept C1 back from the hospital and understood that they could not refuse C1 back from the hospital. During today’s visit, the LPA observed C1 at the facility and briefly spoke with C1, no immediate concerns were noted. 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 a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued. A copy of the report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2