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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850439
Report Date: 04/29/2026
Date Signed: 04/29/2026 04:18:43 PM

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
04/22/2026 and conducted by Evaluator Kelly Dulek
COMPLAINT CONTROL NUMBER: 29-AS-20260422143545
FACILITY NAME:RINCON ASSISTED LIVINGFACILITY NUMBER:
565850439
ADMINISTRATOR:SPRING, REBECCAFACILITY TYPE:
740
ADDRESS:67 EAST BARNETT ST.TELEPHONE:
(805) 643-2176
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY:54CENSUS: 50DATE:
04/29/2026
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Lesley Jamon, Program ManagerTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff told resident not to talk to licensing
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced initial complaint visit related to the above allegation. Upon arrival, the LPA met with facility staff. Facility Designee arrived at 01:55PM and LPA explained the reason for the visit. Entrance interview conducted.

During today's visit, LPA interviewed Program Manager at 02:05PM. Additionally, during the course of the investigation, LPA conducted telephone interviews with Resident #1 (R1) and two (2) additional relevant persons. The following was then determined:

Complaint indicates that two (2) facility managment staff spoke with Resident #1 (R1) and told R1 they should not have spoken to licensing staff. LPA interviewed R1,who stated that is not what they had said, but that management staff had instead encouraged R1 to be patient while management worked with R1 to

Report Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
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 2
Control Number 29-AS-20260422143545
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: RINCON ASSISTED LIVING
FACILITY NUMBER: 565850439
VISIT DATE: 04/29/2026
NARRATIVE
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resolve concerns between R1 and their roommate. R1 indicated that with the encouragement of facility staff, they were able to talk with their roommate and come to a resolution to the conflict R1 and their roommate were having. R1 stated everything is fine and they are free to talk to licensing whenever they wish. R1 stated there was a misunderstanding with what was reported. Interview with program manager revealed that prior to an unrelated licensing visit, R1 had expressed some concerns with their roommate and had requested the roommate change rooms. Management was aware of this situation and was working with both residents to resolve the interpersonal conflict the two (2) had been having. After licensing staff visited the facility, R1 explained the concern they had with their roommate to licensing staff. Management did follow up with R1 to further discuss their concerns and explain the actions the facility was taking to assist R1 in resolving this conflict. Management has since discussed with both roommates and problems have been resolved. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted. A copy of today's report was provided via email.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026
LIC9099 (FAS) - (06/04)
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