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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850482
Report Date: 08/14/2026
Date Signed: 08/14/2026 05:59:36 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
05/18/2026 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20260518125025
FACILITY NAME:BERNADETTE HOME CARE VIFACILITY NUMBER:
565850482
ADMINISTRATOR:MICHELLE RIL RACANFACILITY TYPE:
740
ADDRESS:1525 DAPPLE AVETELEPHONE:
(805) 437-6626
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:6CENSUS: 5DATE:
08/14/2026
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Michelle RacanTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility is not sufficiently staffed to meet the needs of residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Valeria Conway conducted a subsequent complaint visit to the facility above to deliver final findings of the complaint allegation. LPA met with Michelle Racan, Administrator and explained the purpose of the visit. Entrance interview conducted.
Throughout the course of the investigation, LPA conducted interviews and reviewed all documents obtained and the following was determined:

Regarding allegation of “Facility is not sufficiently staffed to meet the needs of residents in care” it was the Reporting Party’s (RP) concern that residents’ needs were not being met due to short staffing. Interviews with the Licensee indicated that two (2) staff members are generally on duty, unless a resident requires one-to-one care. However, resident interviews indicated that staff are at times overwhelmed and that two (2) staff members may be insufficient to provide care and supervision to all residents.

Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2026
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 5
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
05/18/2026 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20260518125025

FACILITY NAME:BERNADETTE HOME CARE VIFACILITY NUMBER:
565850482
ADMINISTRATOR:MICHELLE RIL RACANFACILITY TYPE:
740
ADDRESS:1525 DAPPLE AVETELEPHONE:
(805) 437-6626
CITY:CAMARILLOSTATE:CAZIP CODE:
93010
CAPACITY:6CENSUS: 5DATE:
08/14/2026
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Michelle RacanTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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9
Staff did not ensure resident's scheduled appointments were met
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Valeria Conway conducted a subsequent complaint visit to the facility above to deliver final findings of the complaint allegations. LPA met with Michelle Racan, Administrator and explained the purpose of the visit. Entrance interview conducted.

Throughout the course of the investigation, LPA reviewed all documents obtained and the following was determined:

Regarding allegation of “Staff did not ensure resident's scheduled appointments were met” it was the RP’s concern that they were unable to enter the facility to assess a resident as scheduled. The RP reported that the main entrance was locked and, after ringing the doorbell and knocking for approximately 30 minutes, no staff weas available to provide entry.

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20260518125025
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: BERNADETTE HOME CARE VI
FACILITY NUMBER: 565850482
VISIT DATE: 08/14/2026
NARRATIVE
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Continued from LIC 9099

Interviews with staff indicated that the facility coordinates residents’ medical appointments and visits with family members and outside agencies and adjusts staff schedules as needed to accommodate them. Staff reported that no visitors or service providers are intentionally denied entry. Resident interviews confirmed that staff and the Licensee take scheduled appointments and visits seriously and assist residents in preparing in advance to ensure they are ready on time. Adding that staff may occasionally be assisting other residents with bathing, dressing, or changing and may not be able to respond to the door immediately. An interview with a third-party agency also indicated that the facility is consistent in accommodating scheduled appointments and that none of the agency’s nurses had been denied entry to the facility. 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 allegations “Staff did not ensure resident's scheduled appointments were met” is deemed unsubstantiated at this time.

No citations issued. Copy of this report provided to the Licensee.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20260518125025
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: BERNADETTE HOME CARE VI
FACILITY NUMBER: 565850482
VISIT DATE: 08/14/2026
NARRATIVE
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Continued from LIC 9099

Residents reported extended wait times for assistance. One resident also reported that when a staff member assists Resident #1 (R1) with their daily walk for approximately one (1) hour in the afternoon, only one (1) staff remains available to assist the other residents. Record review further revealed that multiple residents require two-person assistance with transfers, including one resident who requires a Hoyer lift. Additionally, timesheet and schedule for the month of May 2026 were provided and reviewed. They were compared and revealed that, in some instances, only two (2) staff members were schedule from 7:00 A.M. to 7:00 P.M., with no staff listed as scheduled from 7:00 P.M. to 7:00 A.M. The Licensee was unable to provide documentation showing that a staff member was assigned to the NOC shift explaining that a live-in caregiver is available to assist residents in the event of an emergency and that staff verbally assigned to the NOC shift. The Licensee further stated that any additional hours worked by staff would be documented on a separate worksheet. LPA requested the worksheets reflecting staff coverage between 7:00 P.M. to 7:00 A.M., however, Licensee stated that no staff claimed addition hours in the month on May 2026.

Based on observations, documentation, and interviews, the preponderance of evidence standard has been met, therefore the above allegations, “Facility is not sufficiently staffed to meet the needs of residents in care” is deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited at this time (refer to LIC 9099-D) with civil penalty. Administrator was informed that failure to correct the deficiencies may result in civil penalties.

Exit interview conducted, appeal rights discussed, and a copy of this report, civil penalties and appeal rights were provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20260518125025
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: BERNADETTE HOME CARE VI
FACILITY NUMBER: 565850482
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2026
Section Cited
CCR
87411(a)
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87411(a) Personnel Requirements. Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.
This requirement is not met as evidenced by:
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Licensee agreed to provide a plan of action explaining how staff will be properly scheduled throughout all shifts to assist with all residents needs. Licensee will submit action plan to LPA prior to POC due date.
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Based on interviews and record reviews, the licensee did not comply with regulations as some residents needs 2-person assistance and they required the usage of Hoyer lifts and schedule/timesheets shows gaps and no NOC staff available which poses a potential health and safety risk to residents 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.
SUPERVISOR'S NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5