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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191222261
Report Date: 11/19/2025
Date Signed: 11/19/2025 03:57:36 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/19/2025 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20250919132342
FACILITY NAME:TRUDEZ HOME CAREFACILITY NUMBER:
191222261
ADMINISTRATOR:LOPEZ, WALDITRUDEZ P.FACILITY TYPE:
740
ADDRESS:15516 EL CAJON ST.TELEPHONE:
(818) 336-6537
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:6CENSUS: 6DATE:
11/19/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Mary Jane Rivera - AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not follow resident's dietary needs

Staff are using restraints on residents

Staff did not provide proper care and supervision to resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with the Administrator Mary Jane Rivera and explained the reason for the visit.

LPA conducted a physical plant tour at 12:10 PM, requested copies of facility documents relevant to the investigation at 12:23 PM, reviewed records between 12:30 PM to 1:30 PM and interviewed staff and residents between 1:30 PM to 3:00. Regarding the allegation that Staff did not follow resident's dietary needs, it was alleged that the staff are not following Resident #1 (R1)'s dietary restriction. LPA record review revealed that R1 had a medical condition that requires No Added Salt (NAS) and low to no sugar dietary restriction. LPA's interview with staff today revealed that they have three (3) residents with the same medical condition and have been preparing food for these residents for the last three (3) years so the staff is aware of the dietary restriction and have been preparing restricted diet for R1 since admission until R1 left. (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
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 2
Control Number 31-AS-20250919132342
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: TRUDEZ HOME CARE
FACILITY NUMBER: 191222261
VISIT DATE: 11/19/2025
NARRATIVE
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(continued from LIC 9099)

LPA's interview with Resident #2 (R2) today at 1:50 PM, who has the same medical condition, revealed that the staff always follow R2's dietary restriction and gave R2 food that is good for R2 such as vegetables and fruits and always reminds R2 about R2's medical condition and to get better.

Regarding the allegation that the Staff are using restraints on residents, it was alleged that the staff restrained R1 in the wheelchair by a belt. LPA's record review today revealed that R1 has a physician's order for a wheelchair belt for safety. LPA's interview with the staff on 09/24/25 at around 12:30 PM, revealed that they only put the belt on R1 when they transport R1 from bed to the dining/living area as R1 was always trying to get up or stand up and always tried to get off the wheelchair while being transported to and from bed to the living/dining area.

Regarding the allegation that Staff did not provide proper care and supervision to resident, it was alleged that the Reporting Party (RP) witnessed R1 to be in a “zombie” like manner while at the facility. LPA's interview with the Administrator today revealed that the Administrator was not aware of R1 being "zombie" like but noticed that R1's dementia was getting worse and seemed to be declining as R1 barely respond when talked to. LPA's interview with the only two (2) aware residents revealed that they were well taken care of by the staff and provided all the care they need. LPA attempted to interview the other four (4) residents but they were all in hospice service and unable to comprehend and/or converse coherently with LPA.

Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2