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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405801720
Report Date: 03/27/2025
Date Signed: 03/27/2025 12:20:34 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/20/2024 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 29-AS-20241220150220
FACILITY NAME:RESIDENCE, THEFACILITY NUMBER:
405801720
ADMINISTRATOR:MICHELLE MARCOSFACILITY TYPE:
740
ADDRESS:3220 CALLE MALVATELEPHONE:
(805) 596-0812
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:6CENSUS: 4DATE:
03/27/2025
UNANNOUNCEDTIME BEGAN:
12:12 PM
MET WITH:Desiree Verry, Administrator DesigneeTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Staff inappropriately touched a resident in care.
INVESTIGATION FINDINGS:
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At 12:12 p.m. on 3/27/25 Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the facility above to issue final findings. LPA met with Back-up Administrator Desingee Desiree Verry and explained the purpose of the visit.

During the investigation, LPA Jeffries conducted an initial visit on 12/24/24 from 7:47am to 10:15am. LPA Jeffries conducted staff and client interviews and requested relevant documentation. On 1/16/25 from 10:00am to 10:30am, LPA Rankin conducted a collateral visit and interviewed Resident 1 (R1).

Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
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 29-AS-20241220150220
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: RESIDENCE, THE
FACILITY NUMBER: 405801720
VISIT DATE: 03/27/2025
NARRATIVE
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On the allegation: Staff inappropriately touched a resident in care. At this time, based on all interviews conducted by both LPAs, there is no evidence to support that a resident was inappropriately touched. All interviews with staff and administrator stated they have never witnessed Staff 1 (S1) being inappropriate with any resident and residents interviewed stated they feel safe and have not had issues with any staff. S1 was interviewed, where they recounted a situation that occurred approximately one or two weeks prior to the 12/24/24 visit. S1 stated during toileting, R1 was attempting to stand and started to lean forward, and S1 believe R1 would fall. S1 stated they reached out to support R1 and stop them from falling, and they inadvertently touched R1’s breast with one hand. S1 stated there was no malicious intention, and they were trying to protect R1 from falling and sustaining injury. S1 stated R1 had no comment during this interaction or afterward. S1 denied ever inappropriately touching a resident.
Interview with R1 done by LPA Rankin resulted in R1 stating “Oh I like (S1)…(they) are very nice.” There was no concern or hesitation during the conversation. R1 even stated they believed the facility was holding their room for them, so they could return.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

Exit interview conducted, copy of report given.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2