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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850154
Report Date: 06/05/2025
Date Signed: 06/05/2025 04:29:36 PM

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
05/29/2025 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20250529151330
FACILITY NAME:JACKSON HOUSE SANTA PAULAFACILITY NUMBER:
565850154
ADMINISTRATOR:NICOLE LOMELIFACILITY TYPE:
772
ADDRESS:811 TELEGRAPH ROADTELEPHONE:
(619) 507-6385
CITY:SANTA PAULASTATE: CAZIP CODE:
93060
CAPACITY:16CENSUS: 15DATE:
06/05/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Nicole LomeliTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Facility did not admit client that was qualified for admission.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Esther Cortez conducted an initial complaint investigatin visit regarding the above noted allegation. At 10:45 a.m. the LPA met with staff and explained the reason for the visit. Program Director Nicole Lomeli arrived shortly after and was explained the reason for the visit.

During today's visit the LPA interviewed the Program Director and one (1) staff in person, and conducted phone interviews with three (3) Admissions personnel. The LPA revewied facilities internal notes for C1 and obtained pertinent documents relevant to the investigation.

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: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
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-20250529151330
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: JACKSON HOUSE SANTA PAULA
FACILITY NUMBER: 565850154
VISIT DATE: 06/05/2025
NARRATIVE
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Regarding the allegation, “Facility did not admit client that was qualified for admission”; it is the concern of the Reporting Party (RP) that on 05/28/25, a client (name unknown) completed and signed all of the paperwork for their admission to the facility, received confirmation from the facility’s assessor (name unknown) that there was a bed available and they would be accepted into the facility, as they had passed the assessment and there were no objections to their admission. It was further reported that the client then received a call informing them that they were subsequently disqualified and would not be allowed to move in and a reason as to why the client was suddenly disqualified was not given. Program Director Nicole Lomeli indicated that they had a similar incident happened recently with client 1 (C1). However, C1 was not admitted to the facility, did not sign any current admission agreement, and was disqualify due to safety concerns and substance abuse. Program Director Lomeli further indicated that the facility has an off-site admission’s team who is responsible for the client’s admission screening, however she has the ultimate say if they are placed in the facility. Admission staff revealed that the admission process varies depending on where the individual is coming from, but overall, they will take the individual’s information and schedule an assessment with them; this location has a waitlist to be admitted, therefore if an individual qualifies, they will be placed on a wait list and will be notified when there is a bed available. Once the individual is notified that there is a bed available, they will try to obtain all the necessary information from them to ensure a fast and safe admission, however that does not mean they have been admitted to the facility. The admission’s staff will conduct a mini assessment with the individual 24 hours prior to admission to ensure they still qualify to be admitted to the facility. Staff interviews and File review revealed that In the case of C1, they were disqualified based on their mini assessment conducted on 05/28/25 due to recent substance abuse, withholding information, and after Admission’s coordinator and Program Director consulted they were concerned for the safety of staff and C1 due to phone interactions with C1, and did not believe they could meet their needs. Although the allegation may have happened or is valid, based on interviews and file review there is insufficient evidence to support the allegation of, “Facility did not admit client that was qualified for admission.” Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview was conducted. A copy of the report was issued.

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

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2