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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610626
Report Date: 10/09/2025
Date Signed: 10/09/2025 01:56:43 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
08/14/2025 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20250814152448
FACILITY NAME:A PEACEFUL HAVEN RESIDENTIAL COMMUNITYFACILITY NUMBER:
197610626
ADMINISTRATOR:GUTIERREZ, CLAUDIAFACILITY TYPE:
740
ADDRESS:13641 FENTON AVETELEPHONE:
(818) 262-3871
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:6CENSUS: 3DATE:
10/09/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Teresa Giron - StaffTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff do not treat client with dignity and respect

Staff are not safeguarding clients personal belongings
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with staff Teresa Giron who called the Administrator Claudia Gutierrez and explained the reason for the visit. Ms. Gutierrez designated Ms. Giron to sign the report.

LPA conducted a physical plant tour at 9:12 AM, requested copies of facility documents relevant to the investigation at 9:27 AM and interviewed residents and staff between 9:30 AM to 12:00 PM. Regarding the allegation that Staff do not treat client with dignity and respect, it was alleged that Resident #1 (R1) verbalized psychological abuse by the staff. LPA's interview with R1's roommate or Resident #2 (R2) on 08/19/25 and today at 11:23 AM revealed that it was R1 who was abusive to R2 and other residents, R1 watched TV so loud that R2 could not sleep especially during 1:00 AM to 5:00 AM. LPA's interview with two (2) other aware residents confirmed that R1 was mean to them and always yell and rude to them.
(continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
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 2
Control Number 31-AS-20250814152448
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: A PEACEFUL HAVEN RESIDENTIAL COMMUNITY
FACILITY NUMBER: 197610626
VISIT DATE: 10/09/2025
NARRATIVE
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(continued from LIC 9099)

LPA's interview with staff on 08/19/25 and today at 10:23 AM, revealed that there only once incident that someone yelled at R1, it was R2, in their room because R2 could not sleep as R1 was watching and the TV was loud, further interview with staff also revealed that no staff yelled at R1 and it was R1 who was rude to everyone at the facility and gets angry when things did not go on R1's way. LPA's interview with three (3) aware residents also revealed that three (3) out of three (3) residents stated that the staff are respectful and provide all the care they need.

Regarding the allegation that Staff are not safeguarding client’s personal belongings, it was alleged that R1 experienced theft at the facility. LPA's observation on 08/19/25 visit at around 10:00 AM revealed that all the belongings of R1 were still at the facility and carefully packed and being itemized by the administrator to be brought to the new facility where R1 was transferred. LPA's interview with the Administrator today revealed that when R1's belongings were brought to the new facility and the inventory list was presented to R1, R1 signed the list and did not express if anything was missing.

Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
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