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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802000
Report Date: 12/12/2025
Date Signed: 12/12/2025 01:30:45 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
10/13/2025 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20251013182358
FACILITY NAME:DREAM HAVEN OF SANTA PAULAFACILITY NUMBER:
565802000
ADMINISTRATOR:GRACE CATABAYFACILITY TYPE:
740
ADDRESS:404 E. MAIN STREETTELEPHONE:
(805) 420-9605
CITY:SANTA PAULASTATE: CAZIP CODE:
93060
CAPACITY:6CENSUS: 2DATE:
12/12/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:DesigneeAbygail Go VieraTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff are not meeting resident's diapering needs.
Staff are not adequately trained to administer resident's medications.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Esther Cortez conducted a subsequent complaint visit to this facility for the above complaint allegations. LPA met with staff and explained the reason for the visit. Administrator Grace Catabay could not be present during the visit. Designee Abygail Go Viera arrived approximately around 12:00 p.m. and was explainded the reason for the visit.

On 10/17/25, the LPA toured the facility with the Designee, reviewed resident 1 (R1's) PRN medication, and interviewed three (3) staff. The LPA attempted to review staff files however files were not available at the facility and arrived until 4:11 p.m. On 10/20/25, the LPA interviewed two (2) staff, two (2) witnesses, one (1) resident, conducted a file review and collected pertinent documents relevant to the investigation. During today's visit the LPA conducted a file review.

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

DATE: 12/12/2025
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 6
Control Number 29-AS-20251013182358
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: DREAM HAVEN OF SANTA PAULA
FACILITY NUMBER: 565802000
VISIT DATE: 12/12/2025
NARRATIVE
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Regarding allegation, “Staff are not meeting resident's diapering needs”; it was alleged that staff was placing two (2) diapers on Resident #1 (R1) which can lead to skin breakdown. Interview with Staff 1 (S1) confirmed that they placed two diapers on R1 on one occasion, the Designee addressed it with them, and they only place one (1) diaper on all residents now. S1 also revealed that when they work overnight, they only check if the residents need to be changed once. Based on staff interview, there is sufficient evidence to support the allegation and that a violation occurred; therefore, the above allegation is deemed Substantiated at this time.

Regarding the allegation, “Staff are not adequately trained to administer resident's medications”; it was alleged that staff are not administering Resident 1’s medications accurately due to not being adequately trained.

On 10/17/25, the LPA was able to briefly review staff files, and there was little to no documentation of the required staff training including medication training for each staff. Staff interviews revealed that they either did not receive medication training or medication training consisted of Designee Abygail showing them how to administer medication while shadowing her. During the visit conducted on 10/20/25, the LPA observed documentation of the required staff training and when the LPA questioned the documents, Designee Abygail admitted the staff training log had been placed in the staff files after the LPA’s first visit without the staff conducting the required training. Based on record review and staff interview, there is sufficient evidence to support the allegation and that a violation occurred; therefore, the above allegation is deemed Substantiated at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D):



Exit interview conducted, today's reports and appeal rights were reviewed and issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/12/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
10/13/2025 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20251013182358

FACILITY NAME:DREAM HAVEN OF SANTA PAULAFACILITY NUMBER:
565802000
ADMINISTRATOR:GRACE CATABAYFACILITY TYPE:
740
ADDRESS:404 E. MAIN STREETTELEPHONE:
(805) 420-9605
CITY:SANTA PAULASTATE:CAZIP CODE:
93060
CAPACITY:6CENSUS: 2DATE:
12/12/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
01:45 PM
ALLEGATION(S):
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3
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9
Staff are not meeting resident's hygiene needs
Staff does not ensure resident's wall is clean
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Esther Cortez conducted a subsequent complaint visit to this facility for the above complaint allegations. LPA met with staff and explained the reason for the visit. Administrator Grace Catabay could not be present during the visit. Designee Abygail Go Viera arrived approximately around 12:00 p.m. and was explainded the reason for the visit.

On 10/17/25, the LPA toured the facility with the Designee, reviewed resident 1 (R1's) PRN medication, and interviewed three (3) staff. The LPA attempted to review staff files however files were not available at the facility and arrived until 4:11 p.m. On 10/20/25, the LPA interviewed two (2) staff, two (2) witnesses, one (1) resident, conducted a file review and collected pertinent documents relevant to the investigation. During today's visit the LPA conducted a file review.

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

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

DATE: 12/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20251013182358
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: DREAM HAVEN OF SANTA PAULA
FACILITY NUMBER: 565802000
VISIT DATE: 12/12/2025
NARRATIVE
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Regarding the allegation, “Staff are not meeting resident's hygiene needs”; it was alleged that Resident 1’s (R1’s) oral care had been lacking, staff was not brushing R1’s teeth, R1 was observed with dry crusted skin, and long nails. All staff interviewed revealed that all residents receive oral care every day from staff or hospice staff. Interview with Designee Abygail revealed that R1 often gets agitated and refuses oral care, however they do attempt to provide it and routinely check on R1 for anything needed. Staff also revealed that caregivers are not authorized to cut the resident’s nails, and they are cut by their podiatrists. Interviews with two witnesses who visit R1 twice a month revealed that R1 looks clean when they have visited them. One of the witnesses did reveal that they have observed R1 with dry flaky lips on two visits and attempted to swab water around their mouth but R1 has refused. During today’s visit the LPA observed staff check on R1 and provide water. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Regarding the allegation, “Staff does not ensure resident's wall is clean” it is the concern of the Reporting Party that because Resident 1 (R1) would get so agitated they rub their toes to the wall resulting in bleeding and getting the blood on the wall. RP further reported that despite being asked to clean the dry blood the wall was still dirty on a second occasion. Interview with the Designee Abygail Go Viera revealed that on 10/7/25, they were contacted via text message by a credible witness (W1) and advised to have staff clean the wall as it is covered with dried blood. Furthermore, Designee Abygail Go Viera stated that on 10/09/25, they were contacted again by W1 and advised that the wall was still very dirty. Interviews with staff revealed that staff cleaned the wall, a cover on R1’s bed rail was placed to assist with R1 rubbing their feet on the wall, and that they would clean the wall every time they saw it dirty. On 10/17/25, the LPA observed the wall next to R1’s bed to have minor, isolated stained surface marks. There were black and orange stains, however the LPA could not determine if they were blood. On 10/20/25, the LPA observed R1’s wall clean. During today’s visit the LPA observed the wall clean with new color paint. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegations is deemed Unsubstantiated at this time.

Exit interview conducted. Today's report was reviewed and provided to the Designee.

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

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

DATE: 12/12/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 29-AS-20251013182358
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: DREAM HAVEN OF SANTA PAULA
FACILITY NUMBER: 565802000
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2025
Section Cited
CCR
87625(b)(2)
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87625(b)(2) Managed Incontinence. …The licensee shall be responsible for the following: (2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. This requirement is not met as evidenced by:
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The designee grees to submit a plan on how they will ensure staff will comply with managed incontince regulation which include starting a log every time residents are being changed.
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Based on interviews, the licensee did not comply with the section cited above, as R1 was not check periodically at night and double diapered which poses an immediate health and safety risk to residents in care
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Type B
12/15/2025
Section Cited
HSC
1569.69(a)(2)
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1569.69 Employees assisting residents with self-administration of medication: training requirements (a)(2)... shall complete 10 hours of initial training.. 6 hours of hands-on shadowing training, .. and 4 hours of other training or instruction.. This requirement is not met as evidence by:
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Designee agreed to hold training for all staff on H&S code 1569.69 and provide staff missing any of these requirements with medication training, provide proof of training to LPA by 12/15/25.
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Based on record review and staff interviews the Licensee did not comply with the regulation cited above as staff did not have any medication training which possess a potential health, safety and personal rights risk to residents 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.
SUPERVISOR'S NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/12/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6