Complaint Investigation Report

197610111-3-20-2024-31-AS-NGID-D3PLNQ-20240325085439

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

WOODLAND HILLS S.RO , 21731 VENTURA BLVD., STE. 250

This is an official report of an unannounced visit/investigation of a complaint received in our office on

01/04/2024 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20240104131120

This is an amendment of the original report issued 01-10-2024 to clarify the complaint findings.

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent complaint visit to deliver the finding for the above stated allegation. LPA met with the administrator and explained the reason for the visit.

Today 1.10.2024 LPA conducted a tour of the home at 9:35AM. A black moldy patch was observed in bedroom three (3) on the base of the wall 2x2 inches in size. The Administrator (S1) was aware and acknowledged the presence of mold on the base of the wall in bedroom #3 and stated that there was a plumbing issue in bedroom #3 bathroom which caused the mold. The Administrator advice LPA that this is scheduled to be fixed and removed on 1.15.2024. An interview with staff member (S2) also confirmed and acknowledged mold formation in bedroom #3. Therefore, based on interviews, observation, and document review, there is sufficient information to support the allegation. Therefore, this allegation is deemed Substantiated. Deficiencies were issued and recorded on LIC 9099-D. Exit interview conducted. Report signed and delivered. Appeal rights delivered.