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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425801425
Report Date: 09/15/2026
Date Signed: 09/15/2026 01:42:07 PM

Unsubstantiated


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
08/24/2026 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 29-AS-20260824092344
FACILITY NAME:OANI HOME CARE RCFEFACILITY NUMBER:
425801425
ADMINISTRATOR:SHIRLEY CABELIZA OANIFACILITY TYPE:
740
ADDRESS:843 EAST MILL STREETTELEPHONE:
(805) 314-2957
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:6CENSUS: 4DATE:
09/15/2026
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Shirley OaniTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not provide Advance Directives to Medical Personnel
Staff did not ensure resident's room was kept free of ants
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to issue final findings on this investigation. LPA met with Shirley Oani and explained the purpose of the visit. During the investigation, LPA conducted an initial visit on 8/24/26 where LPA conducted an interview with a administrator.

During the investigation LPA interviewed current residents, administrator, reporting party, family members, and Home Health Staff. LPA toured all residents’ rooms and the areas outside the rooms on the initial visit.

On the allegation: Staff did not provide Advance Directives to Medical Personnel

It was alleged the resident arrived at the Emergency Room at or around 2:00 am on 8/20/26 with limited history and without an advanced directive. Per reporting party, the ER staff were told there, “may have been a POLST or advanced directive,” but none was provided at arrival, and the family could not be reached initially to confirm this. Continue on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
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-20260824092344
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: OANI HOME CARE RCFE
FACILITY NUMBER: 425801425
VISIT DATE: 09/15/2026
NARRATIVE
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LPA attempted to contact the reporting party; only one email was received and follow up questions were not answered. Interview via phone call with medical personnel who reviewed notes confirmed the family brought the POLST and residents’ diagnosis to the hospital on the morning of 8/20/26.

On 9/14/26 via phone call LPA spoke with family member of resident and was told that they did not believe the facility had the advance directive or POLST, it was something the family needed to provide and that was not done.

During the visit on 8/24/26, the outside agency who conducted Home Health support were attending to a resident, LPA interviewed them and was informed that the POLST had been included in the Home Health admission packet provided to the family on 6/18/26. The family was instructed to take it to the primary care provider for completion, but per the agency, the appointment was cancelled. The agency staff was unaware whether the document was ever completed or returned to the facility.

A Technical Assistance was issued reminding the facility to document compliance with Title 22, Section 87469 (a), regarding providing information on medical decision making rights, allowing directives in resident files, and ensuring directives are presented during emergencies.

Based on the interviews and record review there is not a preponderance of evidence that the facility had a POLST on file and failed to provide advanced directives to the medical personnel therefore the allegation is UNSUBSTANTIATED at this time.

On the allegation: Staff did not ensure resident's room was kept free of ants

It was alleged that on 8/20/26 resident arrived at the Emergency Room “covered in ants, they were crawling over (their) skin and sheets”.

The reporting party did not provide additional details despite follow up attempts made via email on 8/21/26 and 8/25/26. On 8/25/26 LPA contacted the hospital it was confirmed that staff documented the resident arrived “covered in ants.” On 8/25/26 LPA called Emergency Medical Services (EMS) dispatched to the call, EMS could not provide information due to legal restrictions.

Continue on 9099-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20260824092344
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: OANI HOME CARE RCFE
FACILITY NUMBER: 425801425
VISIT DATE: 09/15/2026
NARRATIVE
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On 8/24/26 Home Health personnel stated they visit the facility regularly and have never observed ants on any residents.

On 8/24/26 LPA conducted a facility tour. No ant activity or trails were observed inside any resident rooms. Two to three ants were observed under an exterior board outside the resident’s exterior door. Two residents were interviewed and denied seeing ants in their rooms, including near food items. All rooms were clean, odor free, and free of debris.

On 9/14/26 via phone call, LPA spoke with a family member who stated that the nurse in the ICU mentioned that ants were report to have been on the resident when they were brought in. The family member stated, “I looked at the bedding (the resident) was brought in with, the sheets, and a pillow, and could not find evidence of any ants, not even one.” Family also stated they didn't see ants ever being a problem at the facility.

Based on interviews and observations, there is not a preponderance of evidence to prove the facility did not ensure residents room was kept free of ants. Therefore, the allegation is UNSUBSTANTIATED at this time.

Report reviewed with administrator and copy left at the facility.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3