<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850442
Report Date: 12/30/2025
Date Signed: 12/30/2025 03:18:47 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
12/26/2025 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20251226092900
FACILITY NAME:ARTESIAN OF OJAI, THEFACILITY NUMBER:
565850442
ADMINISTRATOR:COE, ROBERTFACILITY TYPE:
740
ADDRESS:203 E EL ROBLAR DRIVETELEPHONE:
(805) 798-9305
CITY:OJAISTATE: CAZIP CODE:
93023
CAPACITY:72CENSUS: 38DATE:
12/30/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Andrea Davis-EDTIME COMPLETED:
03:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not refund resident's authorized person upon the death of the resident as required
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct an initial complaint inspection for the allegation listed above. The LPA met with Executive Director Andrea Davis and entrance interview conducted.

During today's visit, LPA interviewed the Executive Director, reviewed and gathered copies of pertinent documents relevant to the investigation.

Report will continue on LIC9099-C, 2nd page.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
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-20251226092900
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: ARTESIAN OF OJAI, THE
FACILITY NUMBER: 565850442
VISIT DATE: 12/30/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding the allegation, “Facility staff did not refund resident's authorized person upon the death of the resident as required”; It was alleged that the facility staff did not provide a refund to Resident #1’s (R1’s) Authorized Person (AP) after R1 passed away within the required 15 days per the admission agreement. It was further alleged that R1’s AP did not receive the refund until 12/29/2025. Interview with the Executive Director (ED) revealed that R1 expired on 11/29/2025, and on 11/30/2025 all their belongings had been removed, and their account had been closed. On 12/1/2025, the ED notified R1’s AP that R1 had been removed from any future billing, and their account was no longer set for any additional payments via text message. If a payment happened to process earlier that morning before everything was updated for the AP to inform them so they could begin the refund process right away. On 12/2/2025, the ED was notified by the AP that December’s payment was withdrawn and to please start the refund.

R1's Admission Agreement states that "discharge/death - any refund of the monthly fee that is owed to the Resident/Representative will be returned within fifteen (15) days." As the resident passed away on 11/29/2025 and all belongings were removed on 11/30/2025, a refund should have been issued by 12/15/2025. The ED stated that she was informed that a check had been generated and mailed out but did not know when. The ED provided the LPA with a detailed ledger for R1 where it revealed that a check for R1’s AP was “effective” 12/16/2025, however was unable to provide documentation verifying the date the check was mailed or issued to the AP. Additionally, the ED stated that they had received confirmation that the check was received on 12/29/2025, and provided the LPA an image of the check with the amount of $8455.00 dated 12/16/2025 and that it had been cleared from the bank today 12/30/2025. Therefore, based on interview and record review, the allegation that " Facility staff did not refund resident's authorized person upon the death of the resident as required " is deemed SUBSTANTIATED at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9009-D):

Exit interview conducted, today’s report and appeal rights were reviewed and emailed to the Executive Director.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20251226092900
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: ARTESIAN OF OJAI, THE
FACILITY NUMBER: 565850442
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/31/2025
Section Cited
HSC
1569.652(c)
1
2
3
4
5
6
7
§1569.652 Termination of admission agreement upon death of resident... and refunds (c) A refund of any fees paid in advance...shall be issued...to the resident’s estate, within 15 days after the personal property is removed.
This requirement is not met as evidenced by
1
2
3
4
5
6
7
On 12/30/25, family of R1 confirmed they had received the refund from the facility and the ED also agreed to review section cited and submit a statement of understanding and plan to ensure future compliance and send to LPA by 12/31/25.
8
9
10
11
12
13
14
Based on interview and record review, the facility did not comply with the above cited section, as R1 passed away on 11/29/25, belongings were removed on 11/30/25 and check issued was dated 12/16/25, which poses a potential personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3