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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609667
Report Date: 10/18/2024
Date Signed: 10/18/2024 03:59:27 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
10/09/2024 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20241009145523
FACILITY NAME:AAA'S ELDERLY CARE INCFACILITY NUMBER:
197609667
ADMINISTRATOR:REYES, MARICELFACILITY TYPE:
740
ADDRESS:3960 WOBURN CTTELEPHONE:
(661) 350-2232
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:6CENSUS: 4DATE:
10/18/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Maricel ReyesTIME COMPLETED:
02:31 PM
ALLEGATION(S):
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Staff do not feed residents food of quantity
Due to lack of supervision, resident has fallen multiple times resulting in injuries
Staff are asking resident for money
INVESTIGATION FINDINGS:
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On 10/17/2024 Licensing Program Analyst (LPA) Melissa Spaeth conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA Spaeth met with the Administrator, Maricel Reyes. LPA explained the purpose of this visit was to deliver the findings.

The investigation consisted of the following: On 10/16/2024, LPA conducted an initial visit, toured the facility, reviewed resident’s files, interviewed three (R1, R2, R3) out of the four residents, interviewed three out of the five staff members, and the Administrator. LPA received copies of the resident’s documents, the resident roster, and staff schedule.

Regarding the allegation: Staff do not feed residents quality food. It’s alleged residents are only served hot dogs, eggs, bologna and served alcohol. R1-R3 confirmed they receive three meals a day along with

Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024
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-20241009145523
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: AAA'S ELDERLY CARE INC
FACILITY NUMBER: 197609667
VISIT DATE: 10/18/2024
NARRATIVE
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snacks. R1-R3 stated the food is nutritious and of good quality. R1-R3 also stated they do not receive alcohol from staff. S4 was unavailable for an interview. S1-S3 stated nutritious meals are prepared each day and staff do not serve alcohol. The Administrator denied this has occurred. LPA Spaeth received a copy of the menu and observed a variety of food being served to the residents.

Regarding the allegation: Due to lack of supervision, resident has fallen multiple times resulting in injuries. It’s alleged a resident has fallen various times and has bruises due to staff leaving a resident outside unattended. R1-R3 stated they have not fallen and have no injuries. S1-S3 stated the residents are not left alone outside and have not fallen. S4 was unavailable for an interview. The Administrator denied this occurred.

Regarding the allegation: Staff are asking resident for money. It’s being alleged that the staff are asking a resident for money. R1-R3 confirmed this has not occurred. R4 was unavailable for an interview. S1-S3 stated they would never ask the residents for money. The Administrator denied this occurred.

Based on the interviews of the residents and staff, the allegations are unsubstantiated.

Exit interview was conducted and a copy of the report was given

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2