<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850154
Report Date: 12/16/2025
Date Signed: 12/16/2025 03:30:56 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
12/15/2025 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20251215152810
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: 13DATE:
12/16/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nicole LomeliTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff yelled at client in care
Staff engaged in actions of punitive nature by flashing lights directly at client's face
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced initial 10-day complaint visit for the above allegations. Upon arrival, LPA met with staff and explained the reason for the visit. Program Director Nicole Lomeli arrived shortly thereafter and was explained the reason for the visit. Entrance interview conducted.

During today's inspection, 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, seven (7) clients, observed video footage from 12/14/25 and obtained copies of resident and staff rosters.

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: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
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-20251215152810
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: 12/16/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding the allegations “Staff yelled at client in care and Staff engaged in actions of punitive nature by flashing lights directly at client's face”; it is the concern of the Reporting Party (RP) that a female staff (name unknown) would yell at Client 1 (C1) and would flash lights directly on C1’s face at night. To investigate the allegation, the LPA conducted in person interviews, and telephonic interviews, and observed camera footage from 12/14/25. Phone interview conducted with C1, revealed that there was an incident where they were going outside for a break and the staff yelled at them and put a flashlight on their face trying to “press them”. Interviews with six (6) other clients revealed that they have never been yelled at and have not witnessed any staff yell at any client, including C1, and they feel safe at the facility. Three (3) of the six (6) clients interviewed revealed that they were present during the incident and all stated that staff 1 (S1) did not yell at C1, however S1 did point their phone flashlight at C1 when they heard them to see who it was since it was dark outside and it was not in a threatening manner. Staff interviews revealed that the smoke area recently changed a few feet due to construction and are further away from outdoor lighting, and staff now use the flashlight on their cell phones to assist with lighting. Furthermore, interview with S1 revealed that they have never yelled at a client, however they confirmed that they placed their flashlight towards C1 but it was not intentional. On 12/14/25, S1 took clients outside for a smoke break, when they heard an unfamiliar voice they turned to C1 to see who they were as it was their first shift working with them, and once they realized who it was, they told C1 to go inside. C1 asked S1 if they could please not shine the light in their face, and S1 turned it away. S1 stated that it was dark outside, and they were trying to see who it was and did not shine the light on C1 as a punishment and turned it away. Lastly all staff interviewed revealed that they have never yelled at any of the clients or witnessed other staff yelling. Although the allegation may have happened or is valid, based on interviews there is insufficient evidence to support the allegations of, “Staff yelled at client in care and Staff engaged in actions of punitive nature by flashing lights directly at client's face.” Therefore, the allegations are 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: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2