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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609667
Report Date: 05/20/2026
Date Signed: 05/20/2026 12:10:04 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/13/2026 and conducted by Evaluator Angelica Segovia
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20260513105954
FACILITY NAME:AAA'S ELDERLY CARE INCFACILITY NUMBER:
197609667
ADMINISTRATOR:REYES, MARICELFACILITY TYPE:
740
ADDRESS:3960 WOBURN CTTELEPHONE:
(661) 350-2232
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:6CENSUS: 5DATE:
05/20/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maricel Reyes- AdministratorTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff kicked resident.
INVESTIGATION FINDINGS:
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On 5/20/2026 at approximately 9:30 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an unannounced initial complaint visit to the facility. LPA was greeted by staff and stated the reason for their visit. The Administrator, Maricel Reyes arrived shortly after to assist with today’s visit.

To investigate the allegation(s), at approximately 10:00 AM, LPA conducted a physical plant tour. By 10:30 AM, LPA requested relevant documentation such as but not limited to: Physician’s Report, Medication List, and Staff roster. From 11:00 AM to 12:30 PM, LPA attempted interviews with six (6) residents (R1-R6), two (2) staff members (S1-S2), and conducted record review.


(continue to LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2026
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 2
Control Number 31-AS-20260513105954
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: AAA'S ELDERLY CARE INC
FACILITY NUMBER: 197609667
VISIT DATE: 05/20/2026
NARRATIVE
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Regarding the allegation: Staff kicked resident. It was alleged that S2 had struck R1. To investigate the allegation, LPA attempted interviews with six (6) residents and two (2) staff members. LPA attempted to interview R1, but they no longer reside at the facility and could not be contacted. LPA attempted to interview R2, R3, and R4 but due to their inability to validate the questions being asked, LPA terminated the interviews. LPA attempted to interview R5 and R6 but they were asleep. LPA’s interview with S1 revealed that R1 had called them on (5/18/2026) to tell them they lied about S2 striking them. Per S1, R1 became upset with S2 for not taking them out to smoke a cigarette. Additionally, S1 revealed, R1 would have hallucinations. LPA’s interview with S2 revealed that they have not hit or mistreated any residents. When questioned if R1 was struck by S2, both S1 and S2 denied the allegation.

LPA conducted a record review of R1’s Physician’s Report. LPA’s record review of the Physician’s Report revealed R1 was prescribed various medications due to their diagnosis. A web search of R1’s medication, revealed some of their medications to cause side effects such as, “….hallucinations, psychosis, and severe mood changes”. During LPA’s physical plant tour, LPA observed S2 to be assisting residents. In addition, LPA’s observation of residents’ interactions with S2 did not show any signs of them being in distress or discomfort surrounding S2’s presence at the facility.

Based on interviews, record review, and observation there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No immediate health and safety issues observed during the day of the visit. Exit interview was conducted and a copy of this report was provided to the Administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2026
LIC9099 (FAS) - (06/04)
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