<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607821
Report Date: 04/21/2025
Date Signed: 04/21/2025 10:55:49 AM

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
04/16/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250416090928
FACILITY NAME:ZION RESIDENTIAL CAREFACILITY NUMBER:
197607821
ADMINISTRATOR:JENNETH AGUILARFACILITY TYPE:
740
ADDRESS:16654 SAN FERNANDO MISSION BLVTELEPHONE:
(818) 620-2202
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 0DATE:
04/21/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:JENNETH AGUILARTIME COMPLETED:
11:05 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff records are not kept on file.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/21/25, at 09:20am, Licensing Program Analysts (LPAs) Gina Saucedo and Angelica Segovia arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Administrator, Jenneth Aguilar. LPAs explained the purpose of this visit was to gather information, interview staff and deliver findings for this complaint.

To investigate the allegation(s), LPAs asked for the census, staff, and resident rosters. LPAs conducted a physical tour and interviewed staff.

LIC 9099C-continued
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025
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 3
Control Number 31-AS-20250416090928
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: ZION RESIDENTIAL CARE
FACILITY NUMBER: 197607821
VISIT DATE: 04/21/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding the allegation: Staff records are not kept on file. Interview with Staff #2 (S2) revealed that Staff 1(S1) did not work at the facility between the dates of (Sept 2022 - March 2023) but was a volunteer. S2 stated S1 was a babysitter for their child. Record review on Guardian and Licensing Information System (LIS) revealed that S1 was on the facility's roster as an employee. Further interview, with the S2 revealed that they accidentally registered S1 as an employee instead of a volunteer and they stated, "It was my fault". When LPAs requested S1's file, S2 could not provide the file. Based on LPA's interviews and record reviews the facility failed to provide the file for S1, therefore the above allegation(s) above is SUBSTANTIATED at this time.

Exit interview was conducted, a citation was issued for the above allegation(s), the appeals rights and a copy of this report was given to the Administrator.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250416090928
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: ZION RESIDENTIAL CARE
FACILITY NUMBER: 197607821
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/05/2025
Section Cited
CCR
87412(h)
1
2
3
4
5
6
7
87412 Personnel Records (h) All personnel records shall be retained for at least three (3) years following termination of employment.
This requirment is not met by:
1
2
3
4
5
6
7
Administrator will send the file for S1 by the end of the POC date.

POC Date:05/05/25
8
9
10
11
12
13
14
Based on record review and staff interview the Administrator failed to provide the staff's file for S1 and had them listed as an employee on Guardian/Licensing Information system.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3