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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850108
Report Date: 11/06/2025
Date Signed: 11/06/2025 07:37:17 PM

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
10/28/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20251028223301
FACILITY NAME:OAK PLACE RESIDENTIAL CAREFACILITY NUMBER:
565850108
ADMINISTRATOR:FLORDELIZA HIPOLITOFACILITY TYPE:
740
ADDRESS:50 OAK ST.TELEPHONE:
(805) 586-4086
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:36CENSUS: 36DATE:
11/06/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Flordeliza "Baby" HipolitoTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff did not treat resident with dignity or respect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Valeria Conway conducted a 10-day complaint investigation visit regarding the above noted allegation. LPA met with Administrator Flordeliza "Baby" Hipolito and explained the reason for the visit. Entrance interview.

LPA conducted an interview with the administrator at 10:00 a.m., record review at 10:10 a.m., toured the physical plant to ensure there were no health and safety concerns, and interviews with staff and clients from 10:45 a.m. to 2:30 p.m. The following was then determined:

It was alleged that “Staff did not treat resident with dignity or respect”. It was reported that the facility driver (S1) observed shouting and speaking to Client #1 (C1) in a rude/aggressive manner. Interview with the administrator revealed that there was an off-site incident in which S1 transported C1 to a doctor’s appointment and became upset during the visit.
Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
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-20251028223301
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: OAK PLACE RESIDENTIAL CARE
FACILITY NUMBER: 565850108
VISIT DATE: 11/06/2025
NARRATIVE
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Continued from LIC 9099

The administrator stated that as result of this event, the licensee suspended S1 until further notice. Interviews conducted with multiple clients revealed that caregivers are generally kind, attentive and caring toward clients. However, several clients reported that S1 has displayed rude and impatient behavior when clients are not ready at the scheduled time for their appointments or when appointments take longer than expected. Clients stated that S1 occasionally becomes visibly upset or expresses frustration in these situations. At approximately 1 p.m., LPA conducted a phone interview with S1. During the conversation, S1 admitted to becoming upset at the doctor’s office because staff were taking too long to check in C1. S1 also stated that during this event, they became annoyed with C1 because C1 “wouldn’t stop yapping”. Based on the information obtained and reviewed, the Department has sufficient evidence to say the alleged violation occurred. Therefore, allegation “Staff did not treat resident with dignity or respect” is deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties.

Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20251028223301
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: OAK PLACE RESIDENTIAL CARE
FACILITY NUMBER: 565850108
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/07/2025
Section Cited
CCR
87468.1
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Personal Rights of Residents in All Facilities (a) Residents... shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by:
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The Administrator has agreed to have an in-service training conducted by an approved CCL Vendor which focuses on resident’s personal rights and submit proof to CCL no later than POC due date.
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Based on interviews, the licensee did not comply with the section cited above as some residents feel harassed and disrespected by some staff members, 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: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3