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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850243
Report Date: 03/14/2026
Date Signed: 03/30/2026 09:18:17 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
05/12/2025 and conducted by Evaluator Zabel Chochian
COMPLAINT CONTROL NUMBER: 29-AS-20250512163131
FACILITY NAME:LAUREL HEIGHTSFACILITY NUMBER:
565850243
ADMINISTRATOR:JOHNNY ORTIZFACILITY TYPE:
740
ADDRESS:13960 PEACH HILL DRIVETELEPHONE:
(805) 292-0700
CITY:MOORPARKSTATE: CAZIP CODE:
93021
CAPACITY:112CENSUS: 68DATE:
03/14/2026
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Sarah Crompton-Smith, Program CoordinatorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff left resident on floor for an extended period of time.
Resident sustained a pressure injury while in care.
Staff leave resident soiled for extended periods of time.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit regarding above allegations. Upon arrival LPA met with receptionist. Executive Director (ED) Joey Alvarado was contacted. LPA spoke with ED and reason for the visit was discussed. ED approved Sarah Crompton-Smith, Program Coordinator to met with LPA and sign today's report.

On 05/12/2025, Community Care Licensing Division received the above allegations. On 05/15/2025, LPA Chochian conducted the initial complaint visit and obtained copy of the resident roster, staff roster and staffing schedule. LPA met with and interviewed four (4) staff from approximately 11am-1pm. LPA conducted a physical plant tour with staff beginning in the Memory Care unit at approximately 1:15pm. During the tour from approximately 1:15pm-2:30pm, LPA conducted interview with five (5) random residents residing in the Assisted Living side and interviewed visitors in the Memory Care unit. LPA also attempted to interview residents in the Memory Care unit. On 2/20/2026, LPA reviewed additional records were reviewed and interview was conducted with Infinite Home Health staff. (Continue to 9099c)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2026
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 3
Control Number 29-AS-20250512163131
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: LAUREL HEIGHTS
FACILITY NUMBER: 565850243
VISIT DATE: 03/14/2026
NARRATIVE
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Following is a summary of the allegations and investigation finding:

Regarding allegation “Staff left resident on floor for an extended period of time” – Information was received that resident #1 had two fall incidents and was left on the floor for an extended time. Also, additional information received that when resident fell (date unknown) R1 contacted the family member who lives close to the facility for help/assistance back into bed. To investigate this allegation, records reviewed revealed that R1 had two falls one on 2/11/2025 and another on 3/23/2025 since admission to the facility memory care on 2/20/2024. Service care plans dated 10/07/2024; 11/24/2024 and 3/26/2025 documented that R1’s level of assistance in mobility/ambulation was minimal to moderate; just prompting and cueing; not required hands on. Records reviewed indicated R1 requiring escort/redirection in the memory care unit and encourage use of walker. Regarding fall incident on 2/11/2025 it was documented that R1 sustained a fall in resident bathroom; R1 fell in the bathroom; R1 had a cell phone which R1 used to call family. The family contacted the facility at which time staff went to assist R1. R1 was found on the floor in R1’s bathroom (incident time documented 8:30pm). The second fall was on 3/23/2025; R1 was out with family; upon returning to the facility R1 sustained a fall transferring out of the family car. Staff were alerted and attended to R1 accordingly. In both fall incidents 911 was contacted and R1 was transferred to the hospital. Staff reported that all residents in memory care are out during the day in the common areas and constantly monitored by staff. Staff stated that when residents are in their room at night, they are checked on at minimum every 2hrs.
Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Staff left resident on floor for an extended period of time” is deemed unsubstantiated at this time.

Regarding allegation “Resident sustained a pressure injury while in care” – Information was received that R1 had a level 1 pressure sore which was do to leaving R1 unattended for long periods each day. R1’s records reviewed did not indicate/note any pressure injury. Interview was conducted with Infinite home Health registered nurse (RN). RN reviewed R1’s records and confirmed that R1 did not have any pressure injury. RN verified through their records that the family took resident to the doctor on 05/08/2025 at which time the doctor provided R1 a referral for home health service; as precaution due to small (dot size) pink rash to R1’s sacral area. RN verified that an LVN from the home health agency evaluated R1 on 5/9/2025, 5/14/202 and on 5/20/2025 and no wound was observed. RN confirmed that they evaluated R1 on 6/2/2025 and no wound was observed to stage. (Continue to 9099c)
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20250512163131
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: LAUREL HEIGHTS
FACILITY NUMBER: 565850243
VISIT DATE: 03/14/2026
NARRATIVE
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Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Resident sustained a pressure injury while in care” is deemed unsubstantiated at this time.

Regarding allegation “Staff leave resident soiled for extended periods of time” -
Information was received that R1 was observed continuously found with a full diaper. Records reviewed and interview conducted with staff revealed that for hygiene and toileting, staff wound provide verbal prompts and cues. Staff reported that despite engorgement from staff R1 continuously demonstrated refusal of assistance with hygiene care and showers. Staff state that the family and doctor were informed. Staff reported that despite R1 refusing hygiene care, R1 was reminded and encouraged good hygiene care; family and doctor were aware of the situation. Staff interviewed reported that residents requiring assistance with toileting and showers are always assisted with hygiene care. Staff reported that residents are not left unclean or unsanitary.
LPA attempted to interview residents in the memory care however they were unable to interview due to cognitive difficulties. LPA did not observe residents in the memory care unit soiled or unkempt during the initial visit and subsequent visits thereafter for other reasons. Visitors in the memory care unit interviewed during the initial visit expressed satisfaction with the care team services. Assisted living resident interviews were also conducted and five (5) out of five (5) residents interviewed reported no issues with care service provided by staff.

Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Staff leave resident soiled for extended periods of time” is deemed unsubstantiated at this time.

Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3