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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609740
Report Date: 04/18/2024
Date Signed: 04/18/2024 11:11:18 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/10/2024 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20240410144308
FACILITY NAME:TRACY'S BOARDING CARE - LASSENFACILITY NUMBER:
197609740
ADMINISTRATOR:MATHEW, THRESIAMMAFACILITY TYPE:
740
ADDRESS:17419 LASSEN STTELEPHONE:
(818) 882-4930
CITY:NORTHRIDGESTATE: ZIP CODE:
91325
CAPACITY:6CENSUS: 5DATE:
04/18/2024
UNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Thresiamma MathewTIME COMPLETED:
11:25 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee abandoned the facility
Licensee did not follow proper transfer/sale guidelines.
Unlicensed care is being provided
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Ray Comer, Gary Tan and Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPAs met with the licensee/administrator, Thresiamma "Tracy" Mathew, and advised her of the complaint. According to the administrator, current license to this address is still valid. There was never a change in ownership. Licensee never abandoned the facility. Licensee did admit that she placed her other facility on Hiawatha (facility #197609741) on sale. Community Care Licensing (CCL) was notified of this on 10/30/23. The administrator stated currently there are five residents living in the home. Four (4) of the five residents are unaware of their surroundings due to their diagnosis. One (1) of the five residents confirms facility is never abandoned and is not notified or ever even aware of any change in ownership.

This agency has investigated the above allegations. We have found that the complaint was unfounded, meaning that the allegations are false, could not have happened, and/or is without a reasonable basis. We have therefore dismissed the complaint. Exit interview conducted and copy of this report issued
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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