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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 567610022
Report Date: 02/20/2026
Date Signed: 02/20/2026 12:05:43 PM

Substantiated


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
02/12/2026 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20260212155920
FACILITY NAME:APPLETON HOMESFACILITY NUMBER:
567610022
ADMINISTRATOR:OLIVAS, MYLINEFACILITY TYPE:
740
ADDRESS:1149 APPLETON RDTELEPHONE:
(747) 237-0417
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:6CENSUS: 4DATE:
02/20/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Myline OlivasTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff do not ensure resident is allowed to have visitors
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced complaint visit for the allegation listed above. At approx 09:30 a.m. LPA met with staff and explained the reason for the visit. Administrator Myline Olivas arrived shortly after.

At approx 09:35 a.m. LPA conducted physical plant, interviewed staff, residents and reviewed and obtained copies of pertinent documentation relevant to the investigation.

It was reported that staff prevented resident from having visitors, as it was alleged on multiple dates, a visitor attempted to visit Resident 1 (R1), but was not allowed to enter the facility.
Interviews and a review of records reflected that R1’s Power of Attorney (POA) informed the Administrator that visitation from a specific individual should be restricted. The Administrator stated that the individual has come to the facility to drop off food and snacks for R1.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
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-20260212155920
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: APPLETON HOMES
FACILITY NUMBER: 567610022
VISIT DATE: 02/20/2026
NARRATIVE
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Continued from 9099

The Administrator further stated that the individual was informed they are not permitted to visit R1 based on the POA’s direction. At the time of the review, LPA did not observe any restraining orders or court documents in R1’s file authorizing or requiring the restriction of visitation. Based on information gathered during this visit, the department has sufficient evidence to determine this allegation occurred. Therefore, the allegation that "Staff do not ensure resident is allowed to have visitors" has been deemed Substantiated at this time.
 
The following deficiencies were observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. A copy of the report and appeal rights were provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20260212155920
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: APPLETON HOMES
FACILITY NUMBER: 567610022
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2026
Section Cited
CCR
87468.1(a)(11)
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To have their visitors...permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement is not met as evidenced by
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Licensee agreed to review section cited then submit a statement of understanding and a written plan to ensure future compliance and submit to CCLD via email by COB 02/27/2026
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Based on interviews and record review, the licensee did not comply with the section cited above as staff prevented R1 from having a visitors which poses as 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: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3