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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850297
Report Date: 08/19/2024
Date Signed: 08/19/2024 12:27:32 PM

Unfounded


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
08/12/2024 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20240812160642
FACILITY NAME:BERNADETTE HOME CARE VFACILITY NUMBER:
565850297
ADMINISTRATOR:ALLAN RACANFACILITY TYPE:
740
ADDRESS:1155 ECHO STTELEPHONE:
(805) 824-2523
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:6CENSUS: 6DATE:
08/19/2024
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Michelle RacanTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Facility staff punch resident
Facility staff are not properly supervising residents who may be a fall risk
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Esther Cortez conducted an initial 10-day complaint visit. At 10:15 a.m. the LPA met with staff and explained the reason of the vist. At 11:10 a.m. co administrator Michelle Racan arrived, and at 12:03 p.m. Administrator Alan Racan arrived at the facility.

During today's visit the LPA toured the facility with staff, conducted three (3) resident interviews, reviewed files, and conducted interviews with the Administrator and Co-Administrator.

Report will continue on LIC9099-C.

Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
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 2
Control Number 29-AS-20240812160642
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: BERNADETTE HOME CARE V
FACILITY NUMBER: 565850297
VISIT DATE: 08/19/2024
NARRATIVE
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On 8/12/2024, the Department received a complaint alleging that Facility staff punch Resident and that staff are not properly supervising residents who may be a fall risk. It is the concern of the reporting party that staff punched Resident #1 (R1), and that R1 fell off their bed and staff did not come to assist them. During today's visit, the LPA, conducted a tour of the facility, interviewed three (3) residents, interviewed facility Administrator and co-administrator and obtained a copy of the facility's resident roster. Administrator's Interviews and review of roster revealed that Resident #1, whom the complaint is in reference to, does not reside at this facility. Based on the information obtained, the allegation is deemed UNFOUNDED at this time. A finding of unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2