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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850607
Report Date: 06/19/2025
Date Signed: 06/19/2025 04:51:37 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
06/19/2025 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20250619095300
FACILITY NAME:PURE RECOVERY CALIFORNIAFACILITY NUMBER:
565850607
ADMINISTRATOR:CARMONA, CHRISTAFACILITY TYPE:
772
ADDRESS:741 MANDALAY BEACH RDTELEPHONE:
(805) 253-0080
CITY:OXNARDSTATE: CAZIP CODE:
93035
CAPACITY:6CENSUS: 4DATE:
06/19/2025
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Jazmin Pedraza- the operation supervisor TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility did not keep current and accurate records
Staff do not have appropriate training
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Esther Cortez conducted an initial 10-day complaint visit to investigate the above allegations. Upon arrival approx at 11:10 am, the LPA was greeted by Staff Joseph Magana who called Administrator Christa Carmona to inform them of the visit. The LPA informed the Administrator of the reason of the visit. The Administrator was not available to be present during today's visit and designated Operation Supervisor Jazmin Pedraza to review and sign the report.

During today’s visit, starting at 11:30 a.m. the LPA and staff conducted a physical plant tour to ensure there are no immediate health and safety concerns and facility is in compliance with Title 22 Regulations, the LPA conducted one (1) staff interview, conducted a file review, and obtained copies of pertinent documents relevant to the investigation.

Report will continue on LIC 9099-C, 2nd page.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
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 4
Control Number 29-AS-20250619095300
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: PURE RECOVERY CALIFORNIA
FACILITY NUMBER: 565850607
VISIT DATE: 06/19/2025
NARRATIVE
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On the allegation, "Facility did not keep current and accurate records"; it is the concern of the Reporting Party (RP) that the treatment/rehabilitation plan for Clients #1 (C1) and #2 (C2) did not contain documented evidence of ongoing review of progress towards reaching established goals., did not contain documented evidence of methods to evaluate achievement of goals and the treatment/rehabilitation plan reviews for C1 and C2 were not signed by staff for each update review and were not completed at least weekly. Furthermore, it was reported that the discharge summary for Client #3 (C3) did not contain documented evidence of reason and plan for discharge.

To investigate this complaint, LPA conducted a file review for C1, C2, and C3, and reviewed the California Department of Health Care Services (DHCS) annual review dated 05/29/2025. File review revealed that on 05/29/2025 the treatment/ rehabilitation plans for C1 and C2 did not contain documented evidence of ongoing review of progress towards reaching established goals as there is no clear update about what was done the past week in the Treatment Plans (TPs), the comment sections were very brief and limited; the TPs did not contain documented evidence of methods to evaluate achievement of goals. The objective or plan was not measurable with a method to evaluate the goals. For example, in C2’s TP it states the objective is to “learn new alternative ways to recognize and manage anger”. And the Plan is “Client will learn body signs of anger and will use the body scale daily.” To make this measurable they should say client will identify three alternative ways to recognize and manage anger. Or Client will learn three body signs of anger and will use the body scaled daily to reduce anger from a 10 on the scale to a 5 over the next seven days. In addition, TP reviews must be done at least every 7 days and signed by both staff and client; TPs for C1 and C2 were done on 5/19/25 and then not updated until 5/27/25 (8 days) and only signed by the clients and not staff. Furthermore, C3 was missing information for where the client was being discharged to. During today’s visit all TP plans for C1, C2, and C3 remained the same. Based on information obtained, file review and a credible witness there is sufficient evidence to support the allegation occurred. Therefore, the allegation of Facility did not keep current and accurate records is deemed Substantiated at this time.

Report will continue on LIC 9099-C, 3rd page.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20250619095300
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: PURE RECOVERY CALIFORNIA
FACILITY NUMBER: 565850607
VISIT DATE: 06/19/2025
NARRATIVE
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On the allegation, “Staff do not have appropriate training”; it is the concern of the Reporting Party (RP) that
records for Staff #1 (S1) and #2 (S2) did not contain documented evidence that the employees had one (1) year of full-time experience, or its part-time equivalent and Staff #3-#6 (S3-6) did not contain documented evidence of at least 20 hours of in-service training per year. To investigate this complaint, the LPA conducted a file review for S1-S6. File review revealed that S1 did not contain documented evidence that they had one (1) year of full-time experience, or its part-time equivalent, working in a program serving persons with mental disabilities or a documented plan of supervision. S1 had an agreement for a Plan of Supervision dated 05/19/25, which was recently created after the Administrator noticed S1 did not have the one year of full-time experience. A review of Relias Training transcript for Staff #3-6 revealed that all four (4) staff had at least twenty (20) hours of in-service training documented on file for 2025. However, the LPA observed that S3 had a total of 18 hours completed on 03/31/2025. Based on information obtained, file review and a credible witness there is sufficient evidence to support the allegation occurred. Therefore, the allegation of Staff do not have appropriate training is deemed substantiated at this time.

The following deficiency was observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22 . Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. Report was reviewed. A copy and appeal rights were issued..

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20250619095300
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: PURE RECOVERY CALIFORNIA
FACILITY NUMBER: 565850607
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/03/2025
Section Cited
CCR
81070(a)
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81070(a) Client Records : The licensee shall ensure that a separate, complete, and current record is maintained in the facility for each client. This requirement was not met as evidenced by:
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The Administrator agrees to complete a plan on how they will ensure all client records will be complete and current and will subit proof by 07/03/2025.
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Based on information obtained, file review and a credible witness Client #1 -3 did not have complete, and current records which posed a potential health, safety or personal rights risk to persons in care.
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Type B
07/03/2025
Section Cited
CCR
81065(n)
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 81065 (n) Personnel Requirements : All direct care staff shall meet the minimum qualifications as set forth in California Code of Regulations, Title 9, Division 1, Chapter 3, Article 3.5, Sections 532.6(h) and (i).This requirement was not met as evidenced by:
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The Administrator agreed that they will create a plan on how they will ensure all staff has the required qualifications and annual training. Will submit plan by 07/3/25
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Based on information obtained, file review and a credible witness, S1 did not contain...one (1) year of full time experience or supervision plan after hired & S3 had 18 documented hours of training in one day which poses/posed a potential health, safety risk to persons 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: 06/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4