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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607449
Report Date: 08/13/2025
Date Signed: 08/13/2025 01:20:08 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
08/11/2025 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250811140537
FACILITY NAME:CROMWELL HOMEFACILITY NUMBER:
197607449
ADMINISTRATOR:RENATA GUZAUSKIENEFACILITY TYPE:
740
ADDRESS:29536 CROMWELL AVE.TELEPHONE:
(661) 702-1808
CITY:VAL VERDESTATE: CAZIP CODE:
91384
CAPACITY:6CENSUS: 6DATE:
08/13/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Renata GuzauskieneTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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1. Staff are not properly trained on emergency evacuation protocols
2. Staff were unable to effectively communicate during an emergency due to a language barrier
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted the initial complaint visit to investigate the allegations mentioned above. LPA met with staff and the Administrator, who was informed the reason of the visit. The following information was provided during the visit.

Allegation # 1: Allegation #1: Staff are not properly trained on emergency evacuation protocols. To investigate this allegation, on 08/13/2025, from 9:15 a.m. to 1:30 p.m., (LPA) conducted interviews with the Administrator, staff, residents, and a witness regarding the concern. According to information obtained, the facility’s location recently experienced an emergency evacuation situation due to nearby fires. Interviews conducted during today’s visit revealed that staff were unable to communicate any emergency evacuation procedures or protocols. This lack of knowledge represents a potential health and safety risk to residents in care. Based on the information interviews conducted, this allegation is Substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
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 5
Control Number 31-AS-20250811140537
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CROMWELL HOME
FACILITY NUMBER: 197607449
VISIT DATE: 08/13/2025
NARRATIVE
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Allegation #2: Staff were unable to effectively communicate during an emergency due to a language barrier. To investigate this allegation, on 08/13/2025, from 8:30 a.m. to 1:30 p.m., (LPA) conducted interviews with the Administrator, staff, (3) out of (6) residents, and a witness regarding the concern. According to information obtained, the facility’s location recently experienced an emergency evacuation situation due to nearby fires. During this event, Licensing and other government agencies attempted to contact the facility to determine whether an evacuation was required; however, staff were unable to communicate effectively in English. Interviews conducted during today’s visit further confirmed that communication with staff was unsuccessful due to their limited English proficiency. This inability to communicate during emergencies poses a potential health and safety risk to residents in care. Based on the information interviews, the allegation is Substantiated at this time.

Citations issued, appeal rights, exit interview conducted and copy of report provided to Administrator.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20250811140537
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CROMWELL HOME
FACILITY NUMBER: 197607449
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/27/2025
Section Cited
CCR
87411(d)
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Personal Requirement - General: (d)All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and
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The Administrator has AGREED to properly train staff on emergency procedures and protocols. LPA also requested a current and updated emergency diaster plan, LIC610D to be submitted for POC.
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effective job performance: This requirement was not met, evidenced by, during today's interviews, facility staff were unable to communicate any emergency evacuation procedures or protocols and the Administrator did not have an emergency plan in place. This is a potential health and safety risk to residents in care.
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Type B
08/27/2025
Section Cited
CCR
87411(d)(3)
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Personal Requirement - General: (d)All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of...(3) Skill and knowledge required to provide necessary resident care and supervision
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Administrator will teach and practice staff to use Google translator app on the cellphone. Administrator will send a statement to LPA that staff are working on using it and practicing English.
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including the ability to communicate with residents. This requirement was not met, evidenced by, during today's visit, staff was not able to communicate effectively in English. This is 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.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
08/11/2025 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250811140537

FACILITY NAME:CROMWELL HOMEFACILITY NUMBER:
197607449
ADMINISTRATOR:RENATA GUZAUSKIENEFACILITY TYPE:
740
ADDRESS:29536 CROMWELL AVE.TELEPHONE:
(661) 702-1808
CITY:VAL VERDESTATE: CAZIP CODE:
91384
CAPACITY:6CENSUS: 6DATE:
08/13/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Renata GuzauskieneTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Licensee did not ensure coverage by a qualified designated substitute during administrator's absence
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted the initial complaint visit to investigate the allegation above. LPA met with staff and the Administrator, who was informed the reason of the visit. The following information was provided during the visit.

Allegation #1: Licensee did not ensure coverage by a qualified designated substitute during the Administrator's absence. To investigate this allegation, on 08/13/2025, from 8:30 a.m. to 1:30 p.m., (LPA) conducted interviews with the Administrator, staff, three (3) of six (6) residents, and a witness regarding the concern. According to information obtained, the Administrator was out of the country visiting family when the facility experienced an emergency evacuation situation due to nearby fires. Phone calls were made to the facility to obtain evacuation information; however, due to staff’s limited English proficiency, clear information could not be obtained. The Administrator informed LPA that two staff members are designated to be contacted in her absence. During today’s visit, LPA observed that staffing levels were sufficient. Although staff’s English proficiency is limited, residents reported that staff can provide care and supervision and perform their duties well.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20250811140537
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CROMWELL HOME
FACILITY NUMBER: 197607449
VISIT DATE: 08/13/2025
NARRATIVE
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While communication challenges were noted, there was no evidence indicating that the facility lacked coverage by a qualified designated substitute. Based on observations and interviews, this allegation is Unsubstantiated at this time.

Exit interview conducted and copy of report provided to Administrator.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5