565850154-3-27-2026-29-AS-KLOZ-DUJ6HT-20260528205004

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850154
Report Date: 03/27/2026
Date Signed: 03/27/2026 02:53:07 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
08/07/2025 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20250807110633

FACILITY NAME:	JACKSON HOUSE SANTA PAULA		FACILITY NUMBER:	565850154
ADMINISTRATOR:	NICOLE LOMELI		FACILITY TYPE:	772
ADDRESS:	811 TELEGRAPH ROAD		TELEPHONE:	(619) 507-6385
CITY:	SANTA PAULA	STATE: CA	ZIP CODE:	93060
CAPACITY:	16	CENSUS: 16	DATE:	03/27/2026
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Nancy Garcia		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff restrict residents from using their mobility devices

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced subsequent complaint visit for the above allegation. Upon arrival, LPA met with Office Manager Nancy Garcia and explained the reason for the visit. Progam Director Nicole Lomeli was not able to be present during today's visit. Entrance interview conducted.

On 08/12,2025, between 09:40 a.m. and 3:30 p.m., the LPA interviewed the Program Director, five (5) staff, two (2) clients, conducted a medication audit and obtained copies of resident records and other pertinent documents relevant to the investigation. On 12/16/2025, between 10:00 a.m. and 3:30 p.m., the LPA toured the facility inside and out, interviewed the Program Director, four (4) staff, six (6) clients, and obtained copies of resident and staff rosters. On 01/14/2026, the LPA conducted interviews with one (1) staff and the Program Director, conducted a file review and obtained perinent copies 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: 03/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2026

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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Control Number 29-AS-20250807110633

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: 03/27/2026

NARRATIVE

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On 03/13/26, between 9:36 a.m. and 3:30 p.m., the LPA conducted a telephone interview with one (1) staff, conducted a file review, and collected pertinent documents relevant to the investigation. On 03/26/26, the LPA conducted one (1) phone interview with former staff, attempted to conduct phone interviews with Client 4 (C4), and one (1) witness, conducted a file review and collected pertinent documents relevant to the investigation. During today's visit the LPA conducted two (2) staff interviews telephonically, and attempted to conduct one (1) telephone interview with a former client.

On the allegation, “Staff restrict residents from using their mobility devices” it is the concern of the Reporting Party (RP) that the Program Director denies admission to individuals using wheelchairs and prohibits the use of canes for clients attending the Day Program. To investigate the complaint, the Licensing Program Analyst (LPA) conducted staff and client interviews and a file review.

Interviews with Program Director Nicole Lomeli and the Executive Clinical Director revealed that the facility is currently licensed only for "ambulatory" clients. This status was confirmed by a review of the facility’s Fire Safety Inspection Request, which reflects a fire clearance for a capacity of 16 ambulatory individuals. Facility management stated that the Fire Marshal explicitly prohibited the admission of non-ambulatory clients. Management further clarified that while they cannot admit non-ambulatory individuals (those requiring staff assistance to exit during an emergency), they do allow clients with short-term needs and have previously admitted clients using canes or crutches.

During the investigation, most staff members interviewed denied witnessing any resident being restricted from using a mobility device. They noted that clients are assessed during intake to ensure they meet ambulatory criteria. Furthermore, all clients interviewed stated they had never seen staff restrict anyone from using a mobility aid. Although the allegation may have happened or is valid, based on the information gathered the department does not have sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation, ‘Staff restrict residents from using their mobility devices” is 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: 03/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2026

LIC9099 (FAS) - (06/04)

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