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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 567609849
Report Date: 07/28/2025
Date Signed: 07/28/2025 12:36:36 PM

Unsubstantiated


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
06/20/2025 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20250620134439
FACILITY NAME:PCS - FERNWOODFACILITY NUMBER:
567609849
ADMINISTRATOR:DANIEL, DADESIIFACILITY TYPE:
735
ADDRESS:515 FERNWOOD DRTELEPHONE:
(805) 307-1810
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY:4CENSUS: 3DATE:
07/28/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Dadesii DanielTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Licensee does not ensure that residents are adequately supervised while in care.
INVESTIGATION FINDINGS:
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LIcensing Program Analyst (LPA) Esther Cortez conducted a subsequent complaint visit to the facility to investigate the above noted allegation. LPA met with Administrator DiDi Daniel and explained the reason for the visit.

On 06/27/2025, the LPA conducted a brief facility tour, starting at 10:10 a.m. the LPA conducted in person interviews with the Administrator, two (2) clients, three (3) staff, and one (1) staff phone interview, conducted a file review, and obtained copies of client records and other pertinent documents relevant tot he investigation. It was determined further investigation was required prior to issuing findings. During today's viist, between 10:00 a.m. and 12:30 p.m. the LPA interviewd the Administrator, and conducted two staff interviews telephonically.

Report will continue on LIC9099-C, 2nd page.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2025
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 2
Control Number 29-AS-20250620134439
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: PCS - FERNWOOD
FACILITY NUMBER: 567609849
VISIT DATE: 07/28/2025
NARRATIVE
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On the allegation, “Licensee does not ensure that residents are adequately supervised while in care”; it is the concern of the reporting party (RP) that on 06/17/2025 there was an emergency call made from the facility due to Resident 1 (R1) having some physical problems and Staff at the facility at the time did not handle the incident well, had no knowledge of R1’s medical conditions, what R1’s baseline behavior and health was, and could not answer any questions about R1 overall. Interviews with staff, including those present on 06/17/25, revealed that R1 had only two weeks living at the facility and were still getting to know them and their history however, all staff stated that they are knowledgeable about all the information provided to them regarding R1 including their medical conditions and baseline behavior. LPA reviewed R1's records which was consistent with information provided by the staff. Staff present during the incident also revealed that they answered all questions however, paramedics requested to speak with management and they called the Administrator who was able to provide any additional information requested. It was further revealed that prior to the emergency call R1 had voiced concerns about their physical problems to staff, the staff relayed the information to the facility’s LVN and the LVN had advised that R1 would be having a medical appointment soon. Additionally, staff revealed that they were unaware that R1 had called 911 as R1 told them they were calling a friend but instead called 911 which did surprised them. The Administrator and staff revealed that they are trained in what to do during a medical emergency and each resident has a medical binder with all their information available and ready to be provided when 911 is called. Interviews with staff and residents, including R1, revealed that R1 has been having issues with adjusting to the facility. An interview with another resident revealed that staff adequately supervise them and help them whenever needed. The LPA observed food being delivered on 06/27/25, and the necessary furniture at the facility. 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 allegations is deemed Unsubstantiated at this time.


Exit interview conducted. Today's report was reviewed and provided.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2