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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425801823
Report Date: 10/28/2025
Date Signed: 10/28/2025 10:17:07 AM

Substantiated


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
10/16/2025 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 29-AS-20251016095337
FACILITY NAME:AMALIA'S RESIDENCE IIFACILITY NUMBER:
425801823
ADMINISTRATOR:DEXTER PRICEFACILITY TYPE:
740
ADDRESS:1206 KENSINGTON AVENUETELEPHONE:
(805) 287-9630
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:6CENSUS: 5DATE:
10/28/2025
UNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Dexter PriceTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff did not give a copy of the admission agreement to the authorized representative
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Rankin and Haner-Tomasko conducted a subsequent complaint visit to issue final findings on this investigation. LPA met with Dexter Price and explained the purpose of the visit. During the investigation, LPA conducted an initial visit on 10/18/25, where LPA conducted interviews with administrators and obtained relevant documents.

Collateral visit was made on 10/17/25 and additional documents were reviewed and relevant documents collected. Interviews with witnessing parties were held on 10/17/25, 10/21/25, and 10/23/25.

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

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
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 9
Control Number 29-AS-20251016095337
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 II
FACILITY NUMBER: 425801823
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/14/2025
Section Cited
CCR
87507(e)
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87507 Admission Agreements (e)The licensee shall provide a copy of the signed and dated current admission agreement, and all subsequent signed and dated modifications, to the resident or the resident's representative...immediately upon signing the admission agreement or modification. This requirement is not met as evidenced by:
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Administrator will mail a copy of the admission agreement and all subsequent signed documents to the residents representative, all future residents/representatives will recieve copies immediately upon signing the admission agreements.
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Based on interviews, and record reviews, the licensee did not comply with the section cited above in that a copy of the admission agreement was not provided to the resident or representative which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 9
Control Number 29-AS-20251016095337
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 II
FACILITY NUMBER: 425801823
VISIT DATE: 10/28/2025
NARRATIVE
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On the allegation: Staff did not give a copy of the admission agreement to the authorized representative

It was alleged by reporting party that a copy of the documents signed, including the admission agreement, was not provided to them.

Licensee stated they give the representatives the binder with the agreement to review and sign, so they have time to review documents when the documents are returned, if the representative asks for a copy the facility provides a copy, but stated, if they didn’t ask for a copy, then the facility does not provide copies. Licensee was unsure if representative asked for a copy.

Title 22 regulations 87507 (e) states “The licensee shall provide a copy of the signed and dated current admission agreement, and all subsequent signed and dated modifications, to the resident or the resident's representative… immediately upon signing the admission agreement…”

Based on interviews conducted, the administrator was not certain if copies were given and the representative stated they were not provided with copies of admissions agreement paperwork. At this time the above allegation was found to be substantiated.

Copy of report and Appeal Rights issued at the time of the visit.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 9
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
10/16/2025 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 29-AS-20251016095337

FACILITY NAME:AMALIA'S RESIDENCE IIFACILITY NUMBER:
425801823
ADMINISTRATOR:DEXTER PRICEFACILITY TYPE:
740
ADDRESS:1206 KENSINGTON AVENUETELEPHONE:
(805) 287-9630
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:6CENSUS: 5DATE:
10/28/2025
UNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Dexter PriceTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff violated residents personal rights
Facility staff did not assist resident with medications as prescribed
Staff left resident in soiled briefs
Staff denied visitation during meal time
Staff put resident on a special diet without physician orders
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Rankin and Haner-Tomasko conducted a subsequent complaint visit to issue final findings on this investigation. LPA met with Dexter Price and explained the purpose of the visit. During the investigation, LPA conducted an initial visit on 10/18/25, where LPA conducted interviews with administrators and obtained relevant documents.

Collateral visit was made on 10/17/25 and additional documents were reviewed and relevant documents collected. Interviews with witnessing parties were held on 10/17/25, 10/21/25, and 10/23/25.
Continued on 9099-C pg1
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 9
Control Number 29-AS-20251016095337
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 II
FACILITY NUMBER: 425801823
VISIT DATE: 10/28/2025
NARRATIVE
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On the allegation: Staff denied visitation during mealtime
It was alleged that visitors would be asked to leave during mealtimes. The response of being asked to leave during mealtime was consistent with those interviewed.

LPA reviewed the visiting policy hanging on the wall as well as the admission agreement, both state visits is from 9 am to 8 pm. Licensee stated the residents like to eat together, and it is for the rights and comfort of other residents that they do not have visitors join at the table. Licensee stated that families can have meals with their resident if they want, but it would be done away from the main table. Licensee stated that the family wanted Resident 1 (R1) to join the other residents during meals so licensee would ask the visitors to leave.

Those interviewed did not state that visitors were required to leave, but that the visitors believed it was a rule and did not push to stay. Alternatives such as the option to stay and eat privately in the rooms with residents were not mentioned when LPA asked about alternatives. Interviews were consistent, in that they would be told it was mealtime and they would be asked to leave. Visitors stated that the “contract…states that between 11 – 12 lunch and 4 – 5 dinner, they want the residence to eat meals together.” LPA could not find documentation to support this rule.

Although information obtained through interviews and discussions during this investigation did not meet the threshold for a citation, the facility has a documented history of similar complaints regarding visits and staff interactions with residents and visitors. This ongoing pattern raises significant concern and underscores the need for the licensee to actively monitor, and address staff conduct to ensure a respectful and safe environment. The facility is reminded of Health and Safety code 1569.313 which states: The facility's policy concerning family visits and communication shall be designed to encourage regular family involvement with the resident client and shall provide ample opportunities for family participation in activities at the facility.
Based on admission agreement verbiage, signage, and interviews, the allegation may have happened, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
Continued on 9099-C pg2
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 9
Control Number 29-AS-20251016095337
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 II
FACILITY NUMBER: 425801823
VISIT DATE: 10/28/2025
NARRATIVE
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On the allegation: Facility staff did not assist resident with medications as prescribed

It was alleged that medication was not given as prescribed, that trazadone medication was missing when given to the new facility, which caused concerns of overmedicating R1, that over-the-counter medications such as a laxative was given to resident without physician’s order.

On 10/17/25 LPA collected Centrally Stored Medication and Destruction Record (CSMDR) from facility, then LPA conducted a collateral visit to the new facility and was able to review bottle 1 of trazadone medication that was listed on the CSMDR from the first facility. The medication counts for bottle 1 was correct. LPA noted that bottle 1 stated there were 3 refills and realized that new facility had a new filled order that stated 1 refill. The allegation stated that a 90-count bottle of Trazodone (Bottle 2) was delivered to the original facility on 9/29/25 but was not transferred to the new facility, raising concerns of potential over medication. On 10/18/25, LPA contacted the original facility to recheck the medication inventory. Bottle 2 was located, an image was sent to LPA, images shows filled 9/25/25 with 2 refills remaining, Rx # matches. LPA requested bottle 2 be taken to new facility, which was done and subsequently by 1:00 pm on 10/18/25. The receiving facility confirmed the bottle contained the full 90-count as prescribed. LPA also verified the remaining medications listed on the CSMDR, and all records were found to be accurate. At this time, all medication is accounted for.

Based on record reviews and documentation obtained, the prescribed medication was administered as ordered. At this time, there is a lack of evidence indicating that any non-prescribed medication was given. Therefore, the above allegation is determined to be unsubstantiated.

On the allegation: Staff violated residents personal rights
It was alleged that staff neglected resident which led to resident getting a pressure wound, and edema’s, further concerns noted regarding declining in abilities, such as patient was able to walk and feed themselves prior to entering the facility. It was also alleged that administrator was not professional when handling and dealing with R1 and R1’s family members. Continued on 9099-C pg3
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC9099 (FAS) - (06/04)
Page: 9 of 9
Control Number 29-AS-20251016095337
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 II
FACILITY NUMBER: 425801823
VISIT DATE: 10/28/2025
NARRATIVE
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Documentation regarding pressure wound and walking difficulties: Face sheet from Health Center dated 2/3/25 stated “Pressure-induced deep tissue damage of sacral region” also noted “muscle wasting and atrophy…Difficulty walking.”

Note from Initial home visit by physician dated 9/10/25, states “Pressure Ulcer of Sacral Region, Stage 1” also notes R1 is “able to ambulate with assist, but mostly wheelchair bound.”

Intake Physical Therapy notes for 9/12/25, “significant mobility impairments requiring max-mod assistance. High fall risk with unsteady gait and weakness in extremities. Can only ambulate 5 feet with [front wheeled walker] and assistance.”

Notes from Skilled Nurse evaluation on 9/15/25 says “wound care for stage 1pressure ulcer” note on 9/22/25 and 9/26/25 states “Wound Care no longer needed, Storage 1 pressure ulcer has resolved.”

Interviews with family state R1 was able to feed themself and walk prior to being admitted to facility on 9/11/25. Review of health professionals’ documentation starting in February of 2025 through September of 2025 show R1 was limited in mobility, able to walk no more than 3 - 5 ft and requiring transfer assistance and mostly wheelchair bound. Documentation and interview with health agency notes that with facilities care, the wound healed within 2 weeks of admittance.

Regarding staff being unprofessional, interviews state that administrator would be upset when asked to change R1, when questioned regarding care, and when visitors remained close to mealtimes. Although information obtained through interviews and discussions during this investigation did not meet the threshold for citation, the facility has a documented history of similar complaints regarding staff interactions with residents and visitors. This ongoing pattern raises significant concern and underscores the need for the licensee to actively monitor, and address staff conduct to ensure a respectful and safe environment. The facility is reminded of 87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (8) To be free from…humiliation, intimidation, and verbal…abuse and (21) To consent to have their relatives and other individuals of their choosing visit during reasonable hours, privately, and without prior notice.

Continued on 9099-C pg4
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 9
Control Number 29-AS-20251016095337
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 II
FACILITY NUMBER: 425801823
VISIT DATE: 10/28/2025
NARRATIVE
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Based on interviews, record reviews, and documentation obtained, there is sufficient information from external agencies indicating that the medical concerns referenced in the allegation were ongoing prior to the resident’s admission to the facility. While the allegation regarding unprofessional staff conduct may have occurred, there is not a preponderance of evidence to determine whether the alleged violation did or did not take place. Therefore, the allegation is deemed unsubstantiated at this time.

On the allegation: Staff put resident on a special diet without physician orders
It was alleged that without physician orders R1 was put on a pureed diet. LPA interviewed licensee who was able to provide doctor orders for 9/17/25 that state “... change diet to pureed food.” Speech Therapy notes on 9/15/25 stated “Recommend downgrade of diet consistencies to pureed solids and nectar thick liquids. Also notes “Discussed pts status and POC with pts… [family relation noted, representative name noted].”

Based on record reviews and documents obtained, at this time the above allegation was found to be unsubstantiated.

On the allegation: Staff left resident in soiled briefs

It was alleged that during a visit with a family member the family member noticed the smell of feces. Family members alleged they were there for a while and no one came to check on the resident until family member asked for the resident to be changed.

Interview with licensee, they stated that they try multiple times a day to change residents, many residents are able to use the restroom. The licensee was unsure of what visit the allegations were referring to because R1 had many visits from family members over the short time they were there. Interview with witness stated they did not notice any odors or concerns while visiting resident. LPA also noted that facility and residents were free of odors and residents appeared clean and dry as they moved about the facility.

Continued on 9099-C pg 5
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 9
Control Number 29-AS-20251016095337
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 II
FACILITY NUMBER: 425801823
VISIT DATE: 10/28/2025
NARRATIVE
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Interviews only provided one occurrence where this was observed for R1. All other interviews did not stated other occurrences.

Based on interviews, there is insufficient evidence to show that the resident was left in soiled briefs. There is no indication that this occurred frequently or over extended periods of time. Therefore, at this time, the above allegation is found to be unsubstantiated.

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

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 9