565802444-3-13-2025-29-AS-KLOZ-DF3UF2-20250324153202

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802444
Report Date: 03/13/2025
Date Signed: 03/13/2025 04:54:40 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
03/21/2024 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20240321154046

FACILITY NAME:	LAND OF ENCHANTMENT 1 BOARD AND CARE LLC		FACILITY NUMBER:	565802444
ADMINISTRATOR:	ROXANA LARA		FACILITY TYPE:	740
ADDRESS:	78 W GAINSBOROUGH RD		TELEPHONE:	(805) 601-5202
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	6	CENSUS: 5	DATE:	03/13/2025
		UNANNOUNCED	TIME BEGAN:	10:41 AM
MET WITH:	Roxana Lara		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff engaged in inappropriate interactions with an adult on the premises in the presence of a resident.
Staff did not provide a comfortable environment for residents.
Staff did not ensure that residents had appropriate furniture.
Illegal eviction.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced subsequent visit to investigate the allegations listed above. LPA Urena met with the Manager Tiffany Lara and explained the reason for the visit. The licensee Roxana Lara arrived shortly thereafter. The LPA and the Manager conducted a tour of the facility to ensure there are no health or safety concerns. LPA Urena interviewed the Licesee and staff at 10:55 a.m.

On 03/22/2024, Licensing Program Analysts (LPAs) Brittany Thomas and Martha Arroyo conducted an unannounced initial complaint investigation for the allegations listed above. LPAs toured the facility to ensure there are no health or safety concerns. At 11:14 a.m., LPAs conducted an interview with the Administrator, three staff members, and three residents between 10:52 a.m. and 12:45 p.m., conducted a resident’s file review at 12:10 p.m., and obtained copies of pertinent documents relevant to the investigation.
Continues on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

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 3

Control Number 29-AS-20240321154046

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: LAND OF ENCHANTMENT 1 BOARD AND CARE LLC	FACILITY NUMBER: 565802444
	VISIT DATE: 03/13/2025

NARRATIVE

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Staff engaged in inappropriate interactions with an adult on the premises in the presence of a resident.
On the allegation of inappropriate interactions by staff, the concern of the reporting party is that while the RP was talking to with the Licensee in the backyard regarding some concerns, a facility staff (S1) intervened in the discussion. S1 came very close to the RP’s face. The incident occurred very close to one of the residents’ rooms, and another resident was sitting in the dining room. On 03/22/2024, LPAs Arroyo and Thomas interviewed S1, and S1 stated that the RP does not allow personal space for staff: RP answers the facility phone, goes into the kitchen while staff are preparing meals, and goes into other residents’ rooms. Furthermore, the LPAs interviewed residents and their representatives, and the interviews revealed that residents and their representatives are satisfied with the facility staff and had no concerns. On 03/13/2025, LPA Urena interviewed the Licensee and S1 about engaging in inappropriate behavior towards any of residents or any visitor to the facility, and S1 denied being disrespectful or displaying inappropriate behavior. to anyone at the facility. The Licensee denied that the staff engaged in inappropriate interaction with others at the facility.

Based on the information obtained through interviews; although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff did not provide a comfortable environment for residents.
On the allegation that staff does not provide a comfortable environment, it is the concern of the RP that they observed two broken recliners in the living room. On 03/22/2024, at 11:14 a.m. Licensing Program Analysts (LPAs) Brittany Thomas and Martha Arroyo along with the Licensee conducted a tour of the facility to ensure there were no health or safety concerns. At the time of the visit, the LPAs did not observe any concerns. Furthermore, the LPAs conducted residents’ interviews, and responsible parties’ interviews. All interviews (residents’ and responsible parties’) revealed that they were happy with the facility and staff, and did not have any concerns or issues. The RP stated that they had noticed some broken chairs in the common area. On 03/13/2025, LPA Urena interviewed the Licensee and S1, and they denied having any broken recliners.

Based on the observations, and information obtained through interviews, the facility has appropriate furniture for residents in care. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20240321154046

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: LAND OF ENCHANTMENT 1 BOARD AND CARE LLC	FACILITY NUMBER: 565802444
	VISIT DATE: 03/13/2025

NARRATIVE

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Amended report to correct formatting.
Staff did not ensure that residents had appropriate furniture.
On the allegation that staff did not ensure residents have appropriate furniture, the RP’s concern is that they observed that a resident’s bed was broken, and that the staff did not inform the resident’s next of kin about it. On 03/22/2024, at 11:14 a.m. Licensing Program Analysts (LPAs) Brittany Thomas and Martha Arroyo along with the Administrator conducted a tour of the facility to ensure there were no health or safety concerns. At the time of the visit, the LPAs did not observe any concerns, and furniture appeared in good condition throughout the facility. Furthermore, the LPAs conducted residents’ interviews, and responsible parties’ interviews. All interviews (residents’ and responsible parties’) revealed that they were happy with the facility and facility staff, and did not have any concerns or issues. On 03/13/2025, LPA Urena interviewed the Licensee and S1, and they stated that they were not aware of resident's bed broken.

Based on the observations, and information obtained through interviews, the facility has appropriate furniture for residents in care. Therefore, the allegation is deemed Unsubstantiated at this time.

Illegal eviction.
On the allegation of illegal eviction, the RP’s concern is that the Licensee threaten to evict R1 as retaliation due to the RP bringing their concerns to the Licensee about a facility staff. On 04/04/2024, during an interview via telephone with Licensing Program Manager (LPM) Kasandra Lopez, the RP stated that the Administrator did not give R1 a written eviction notice; but gave R1’s representative a verbal warning that R1 could be evicted due to the “representative raising their voice to staff.” On 03/13/2025, LPA Urena interviewed the Licensee about the eviction threat, and the Administrator denied making such threats. Furthermore the Licensee provided a letter from the R1's representative that they were giving the facility the 30 day notice to vacate the facility on their own accord.

Although the allegation may have happened or is valid, based on the interviews, there is not sufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

No citations were issued at this time. Exit interview was conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC9099 (FAS) - (06/04)

Page: 1 of 1

Edit History

Created By	Creation Date
Sandra Urena	03/13/2025 11:22:46 AM
Editors	Edit Dates 03/13/2025 01:13:59 PM
Sandra Urena Sandra Urena Sandra Urena Sandra Urena	03/13/2025 01:13:59 PM 03/13/2025 01:11:47 PM 03/13/2025 11:24:15 AM 03/13/2025 11:23:14 AM
*Only past five edits are shown

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3