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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609872
Report Date: 03/11/2024
Date Signed: 03/11/2024 03:56:35 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
03/11/2024 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20240311142157
FACILITY NAME:ANAVERDES VILLAFACILITY NUMBER:
197609872
ADMINISTRATOR:ESTRELLA, ERWINFACILITY TYPE:
740
ADDRESS:37335 PAINTBRUSH DRTELEPHONE:
(661) 526-7000
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:6CENSUS: 4DATE:
03/11/2024
UNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Erwin EstrellaTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff restrained residents in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst Melissa Spaeth (LPA) and Lorena Casillas conducted an unannounced visit and was greeted by the Administrator, Erwin Estrella. LPA Spaeth stated the purpose of the visit was to investigate a complaint investigation regarding the allegation listed above. The Administrator confirmed there are four residents.

It is alleged that staff have restrained residents in care.

LPA Spaeth and LPA Casillas conducted a tour of the facility at 3:10 to 3:30 pm. LPAs observed a resident was freely walking on their own through the facility. Two residents were waching television in the family room and a resident was resting in their room. LPA's observed there were no restraint devices in each of the residents' rooms. During the tour, LPAs did not observe any health or safey issues.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024
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-20240311142157
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: ANAVERDES VILLA
FACILITY NUMBER: 197609872
VISIT DATE: 03/11/2024
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
LPA Casillas reviewed the residents files at 3:10 pm until 3:30 pm. LPA Spaeth interviewed three of the four residents and two caregivers. Residents 1, 2, and 3 unanimously confirmed they have never been restrained in any way since living in the facility. LPA was unable to interview Resident 4. LPA Spaeth interviewed the two caregivers. S1 and S2 stated they have never restrained a resident while in care. Both staff members also confirmed that the Administrator has never instructed staff to restrain a resident while in care.

Based upon LPAs observations and interview of staff and residents, the complaint is unsubstantiated.

Exit interview conducted and a copy of the report was given to the Administrator.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2