425801497-5-13-2025-29-AS-KBUY-DH4TEV-20250528144034

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425801497
Report Date: 05/13/2025
Date Signed: 05/13/2025 10:50:06 AM

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
03/27/2025 and conducted by Evaluator Melisa Rankin

COMPLAINT CONTROL NUMBER: 29-AS-20250327143338

FACILITY NAME:	AMALIA'S RESIDENCE		FACILITY NUMBER:	425801497
ADMINISTRATOR:	DEXTER PRICE		FACILITY TYPE:	740
ADDRESS:	1002 GUNNER STREET		TELEPHONE:	(805) 922-5475
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93458
CAPACITY:	6	CENSUS: 6	DATE:	05/13/2025
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	DEXTER PRICE		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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Facility staff did not meet resident's needs
Facility staff violated resident's personal rights

INVESTIGATION FINDINGS:

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On 5/13/25 at 10:25 a.m. Licensing Program Analyst (LPA) Melisa Rankin conducted a subsequent complaint visit to the facility above to issue final findings. LPA met with Dexter Price and explained the purpose of the visit. During the initial visit on 4/1/25 LPA Rankin toured the facility interviewed administrators, interviewed residents and obtained relevant documents.
On the allegations: Facility staff did not meet resident's needs and Facility staff violated resident's personal rights.
Complaint states reporting party spoke with Resident 1 (R1) and that R1 did not want to return to the facility. Per Reporting Party, R1 was upset and alleged the facility was neglectful and abusive.
LPA Rankin contacted credible witness (W1) on 4/3/25. W1 visits facility monthly, or more if needed. W1 stated R1 is "very difficult, makes up stories, doesn't work with plan of care." W1 explained that R1 does requests service and then cancels same day as appointments and refuses assistance with Adult Daily Living (ADL) care such as showering, wrapping of legs, and changing of adult incontinence briefs. R1 has cancelled physical therapy, home health aides, and caregivers. Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

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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Control Number 29-AS-20250327143338

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: AMALIA'S RESIDENCE	FACILITY NUMBER: 425801497
	VISIT DATE: 05/13/2025

NARRATIVE

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LPA received paperwork from administrator showing refused services by R1 for imaging orders, gastroenterology appointments, mental health services, caregivers, leg wrapping and assistance with incontinence which also has a note that R1 was warned they will develop pressure sores if R1 is not complaint. W1 stated they have not witnessed any neglect or abuse of any residents including R1. W1 stated “(R1) was the one that was refusing showers and the get up from the chair.” W1 stated “(R1) was incontinent and needed to get up and clean (themselves) and refused and sat there in wet diapers." W1 stated facility never refused any services to come to attend to R1, but that R1 continued to refuse the care.

LPA reviewed Police report. Report stated “(R1) alleged abuse and said nothing else. (R1) did not wish to speak about anything with law enforcement. No further information given or evidence any abuse occurred.”
LPA spoke with local ombudsman who attempted to interview R1. Ombudsman stated R1 doesn’t like to talk too much, just responds yes or no. Ombudsman stated R1 would not provide any details and that R1 would not give consent for ombudsman to release information to licensing.

LPA Rankin interviewed four (4) residents in private at the facility on 4/1/25, all 4 residents did not have complaints about the facility and the care. All residents were observed to be in clean rooms, clean clothes, and were awake and able to answer questions. Two (2) of the four (4) residents had either an inability to speak or had a cognitive decline, but these two residents communicated with LPA with nodding or hand movements confirming or denying in response to questions being asked. Both residents were observed to be cared for, awake and alert, and comfortable with caregivers.

Records review state resident was admitted to the facility on 9/12/24. Intake Physician report with a faxed date of 9/9/24 states R1 arrived at the facility able to handle their own ADLs, they are able to follow instructions and communicate needs. No cognitive concerns noted. At time of admittance resident was noted as “ambulatory”. Record from medical services show R1 was seen monthly, often more than once a month, and that multiple referrals were made for care.
Based on interviews, and records reviewed. The allegations may have happened or is valid, but there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Copy of report printed and given to Licensee.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

LIC9099 (FAS) - (06/04)

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