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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850067
Report Date: 01/13/2023
Date Signed: 01/13/2023 11:19:38 AM

Unsubstantiated


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
01/12/2023 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20230112141812
FACILITY NAME:VISTA AT SIMI VALLEYFACILITY NUMBER:
565850067
ADMINISTRATOR:RICE, DOUGLASFACILITY TYPE:
740
ADDRESS:1236 ERRINGER ROADTELEPHONE:
(805) 351-8802
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:130CENSUS: 66DATE:
01/13/2023
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Dan ZaharoniTIME COMPLETED:
11:28 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is operating without a certified administrator
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Teresa Camara conducted a complaint visit to the facility. LPA met with licensee Dan Zaharoni and explained the reason for the visit.

On 12/2/2022, the management company for this facility changed. During the transition Briman Vivar (Vivar) has been the acting administrator. LPA confirmed that Vivar has a current administrator certification. Licensee acts as a back-up to the acting administrator. Licensee is in the process of obtaining his own adminsitrator certification and intends to name Vivar as the administrator/executive director of the facility. Licensee will submit all necessary documentation in order to make the change to Vivar as the administrator by 1/20/2023.

Based on the above information the allegation that the facility is operating without a certified administrator is deemed Unsubstantiated at this time. Exit interview conducted. Today's report was emailed to the licensee and acting administrator.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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