565850429-1-27-2026-29-AS-DPEA-DQR7Y5-20260127210411

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850429
Report Date: 11/24/2025
Date Signed: 01/27/2026 04:49:27 PM

Substantiated

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
06/18/2025 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20250618161202

FACILITY NAME:	MOMENTUM AGENCIES CREATIVE ARTS CENTER NORTH		FACILITY NUMBER:	565850429
ADMINISTRATOR:	ANDERSON, LORI		FACILITY TYPE:	775
ADDRESS:	2400 WILLOW LANE		TELEPHONE:	(818) 782-2211
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91361
CAPACITY:	100	CENSUS: 51	DATE:	11/24/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Daniel Program Manager		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Licensee did not ensure a complete record was maintained for client
Staff are not following client's needs and services plan

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to deliver final findings for the above allegations. During today’s visit, LPA met with Program Manager and explained the reason for the visit.

On 06/18/2025, the Department received a complaint regarding the above allegations,
During the initial complaint visit on 06/24/2025, at approximately 10:00 a.m., LPA Cortez met and interviewed the SD. LPA requested and obtained documents pertinent to the investigation. SD was not able to provide Admission's agreement, needs and service plan and/or complete file for Client 1 (C1). LPA Chochian conducted a subsequent visit on 08/13/2025. At approximately 2pm, LPA requested and reviewed seven random client files including C1’s records and interviewed two staff at approximately 3pm.

To investigate the complaint allegations, LPA reviewed a random sample of client records and conducted interview with two (2) staff. (Continue to LIC9099c.)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 11/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2025

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-20250618161202

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: MOMENTUM AGENCIES CREATIVE ARTS CENTER NORTH	FACILITY NUMBER: 565850429
	VISIT DATE: 11/24/2025

NARRATIVE

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Regarding allegations, Licensee did not ensure a complete record was maintained for C1 and Staff are not following C1’s needs and service plan: Information was received that C1 was denied services because the program was missing medical documents. Reporting party (RP) stated that C1’s medical documents were provided to the program in 10/2024, upon admission to the program. It was also reported that the program did not have C1’s documents on file which address how to feed C1, what they are supposed to feed C1, and the method they are supposed to feed C1. RP stated that they've been feeding C1 at program all this time. RP stated that C1 hasn't been allowed to attend since 6/10/25 due to missing records which the program misplaced.

LPA reviewed C1’s file and conducted interviews with staff and other potential witness. Records obtained on 6/24/2025 and 8/13/2025 were reviewed. Interview with staff and potential witnesses revealed that it was discovered that C1’s records were not updated/renewed sometime in 6/2025, therefore C1 was not allowed to continue service at the program. Records reviewed revealed that C1’s last physician record on file was dated 9/11/2024 indicating C1 requires assists feeding; last Individual Program Plan (IPP) began 8/7/2023 and ended 9/2023. No needs and services plan observed on file for C1 on 6/24/2025 and 8/13/2025. Furthermore, there was no current IPP for C1 on file on 08/13/2025. Interview with potential witness confirmed C1 did not attend program for approximately 4 to 5 weeks until records were updated. Currently C1 is attending program and records have been updated.

Based on the records reviewed and interviews conducted, there was sufficient evidence to show that “Licensee did not ensure a complete record was maintained for C1 and Staff are not following C1’s needs and service plan”. Therefore, the allegation is deemed Substantiated at this time.

Exit interview conducted, deficiency cited, copy of this report and appeal rights provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 11/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20250618161202

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: MOMENTUM AGENCIES CREATIVE ARTS CENTER NORTH	FACILITY NUMBER: 565850429
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/24/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/02/2025 Section Cited CCR 82077.2(b)(2)BC	1 2 3 4 5 6 7	(b) Prior to accepting such a client into care, the licensee shall complete the following: (2)A Needs and Services Plan, as required by the program-specific regulations, that includes all of the following: (B)A method for feeding the client... (C)A method for determining clients needs.	1 2 3 4 5 6 7	Senior Direcotor stated that the client records were reviewed and updated according since the initial visit. SD agreed to submit a self-certification letter explaining what steps program will take to ensure client records are complete with updated records. Submit correction by POC date 12/2/2025.
	8 9 10 11 12 13 14	This requirement is not met as evidence by: Based on records review and interviews, licensee did not comply with section cited above. No needs and services plan to address care needs and current IPP observed on file for C1.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 11/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2025

LIC9099 (FAS) - (06/04)

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