565802469-3-4-2026-29-AS-DPEA-DSKUPT-20260327154605

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802469
Report Date: 03/04/2026
Date Signed: 03/04/2026 02:29:42 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/16/2025 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20251116161517

FACILITY NAME:	CARMEL HOME		FACILITY NUMBER:	565802469
ADMINISTRATOR:	CRISTINA WILLIAMS		FACILITY TYPE:	740
ADDRESS:	1090 CARMEL DR		TELEPHONE:	(805) 955-0435
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY:	4	CENSUS: 4	DATE:	03/04/2026
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Cristina Williams		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff spoke to resident in an inappropriate manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent complaint visit to investigate the allegation listed above. Upon arrival LPA met with Cristina Williams and explained the reason for the visit.
On 11/17/2026, LPA Martha Arroyo initiated the 10-day visit between approx. 03:00 p.m. - 04:00 p.m. LPA Arroyo conducted an interview with the Administrator Assistant, conducted a file review, and obtained copies of pertinent documents relevant to the investigation. On 02/12/2026, between approx. 02:00 p.m. to 03:00 pm, LPA Balisi conducted a subsequent complaint visit. During the visit, LPA conducted physical plant tour, interviewed staff, residents and reviewed and obtained copies of pertinent documentation relevant to the investigation. On 02/19/2026, LPA interviewed Tri-Counties Regional Center Quality Assurance Specialist (QAS) Patrick Brown.

It was reported that "Staff spoke to resident in an inappropriate manner" as it was alleged that Staff #1 (S1) said the following to Resident #1 (R1), "Why are you so fat?".

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026

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-20251116161517

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CARMEL HOME	FACILITY NUMBER: 565802469
	VISIT DATE: 03/04/2026

NARRATIVE

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Interviews and record review reflected that on 11/14/2025, S1 was assisting R1 in the restroom and was overheard stating, “Why are you so big?” Four (4) staff members were interviewed. Two (2) staff reported they have never observed staff speak inappropriately to any residents.

One (1) staff member who was aware of the incident believed the comment was inappropriate. Another staff member who was aware of the incident stated the comment did not appear to be directed at R1 but rather was said aloud as a general remark. R1 was checked following the incident. Due to hearing impairment, R1 did not indicate awareness that any inappropriate comment had been made. An internal investigation was conducted from 11/17 to 11/19/2025 and included interviews with four (4) staff members and R1.The investigation found insufficient evidence to substantiate that S1 was verbally abusive toward R1.The evidence indicated that the comment regarding weight was made to a co-worker and not directed at R1.

Per interview with S1, the comment “heavy” was stated because usually R1 assist with their mobility however, during the time R1 was not being supported by any device therefore, making the transfer “heavy” than usual. R1 did not demonstrate awareness of the comment or any resulting harm. LPA reviewed the internal investigation findings with Quality Assurance Specialist (QAS) Brown, who agreed the comment did not appear to be directed at R1 and that R1 showed no awareness of or harm from the remark. Furthermore, Brown did not express any concerns for staff saying anything inappropriate to any residents at this time. LPA attempted to interview R1, but LPA was not able to successfully communicate with R1 during the investigation. Based on the information obtained during the investigation, even though S1 made a remark regarding R1’s weight it was not intended to be negative and misconstrued due to language barrier. S1 was remorseful of the situation and agreed to additional training. Therefore, the above allegation “Staff spoke to resident in an inappropriate manner” is deemed UNSUBSTANTIATED at this time.

Exit interview conducted and copy of report issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026

LIC9099 (FAS) - (06/04)

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