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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850244
Report Date: 10/22/2024
Date Signed: 10/22/2024 12:20:39 PM

Substantiated


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
10/15/2024 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20241015152342
FACILITY NAME:PALS SKILLS CENTERFACILITY NUMBER:
565850244
ADMINISTRATOR:POURAN MOUSAZADEHFACILITY TYPE:
775
ADDRESS:1310 E MAIN STREETTELEPHONE:
(562) 489-3859
CITY:SANTA PAULASTATE: CAZIP CODE:
93060
CAPACITY:30CENSUS: 8DATE:
10/22/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Pouran MousazadehTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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 Staff utilizes an inappropriate lock on facility doors.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced initial 10-day complaint visit for the above allegation. Upon arrival, LPA met with the Program Director (PD), Pouran Mousazadeh, and explained the reason for the visit. Entrance interview conducted.

On the allegation, "Staff utilizes an inappropiate lock on facility doors"; it is the reporting parties concern that Facility had the front doors key locked preventing individuals from entering/exiting building and the back exit had a door bolt. During today's inspection, at 10:30 a.m. the LPA observed, through the glass door, the PD unlocked the door with their key, to let the LPA in. The LPA interviewed the PD while taking a tour of the facility. At 10:33 am the back door was locked from the inside with a door bolt that can be open/closed from the inside. Based on observations, there was Sufficient evidence to prove doors are being locked. Therefore, the allegation is deemed Substantiated at this time. The following deficiencies were observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Civil penalties assessed. Exit interview conducted, report and appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
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-20241015152342
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: PALS SKILLS CENTER
FACILITY NUMBER: 565850244
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/23/2024
Section Cited
CCR
82020
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82020 Fire Clearance. All day programs shall secure through the licensing agency and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal. This requirement is not met as evidenced by:
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Program Director unlocked both doors and agreed to not lock doors and submit a plan on how they will ensure the safety of residents and facility compliance with the fire clearance to CCL by 10/23/2024.
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Based on observation and interview the licensee did not comply with the section cited above as front door was key locked during operating hours, with clients inside, which is not within their approved fire clearance which poses an immediate safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC9099 (FAS) - (06/04)
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