195850339-8-26-2026-29-AS-KHEN-DXDVJT-20260828162916

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850339
Report Date: 08/26/2026
Date Signed: 08/26/2026 02:02:36 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
07/08/2026 and conducted by Evaluator Quoc Huynh

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20260708103856

FACILITY NAME:	INN AT THE PARK VENTURA		FACILITY NUMBER:	195850339
ADMINISTRATOR:	ANGUIANO, ROSE		FACILITY TYPE:	740
ADDRESS:	21200 VENTURA BLVD		TELEPHONE:	(818) 884-7100
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91364
CAPACITY:	200	CENSUS: 154	DATE:	08/26/2026
		UNANNOUNCED	TIME BEGAN:	01:47 PM
MET WITH:	Rose Anguiano - Administrator		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Staff did not prevent a resident from threatening another resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Quoc Huynh conducted a subsequent complaint visit to deliver findings for the above allegation. The LPA arrived at 1:47PM and met with the Administrator Rose Anguiano. Entrance interview conducted.

On 07/14/2026, the LPA conducted an initial visit Between 1:57PM and 3:06PM, the LPA conducted a physical plant tour, interviewed three (3) residents and the Administrator and Assistant Administrator, and reviewed and obtained pertinent documents.

On 08/11/2026, the LPA conducted a subsequent visit. Between 10:31AM and 2:20PM, the LPA conducted a physical plant tour and interviewed three (3) staff.

Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20260708103856

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: INN AT THE PARK VENTURA	FACILITY NUMBER: 195850339
	VISIT DATE: 08/26/2026

NARRATIVE

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During today’s visit, the LPA and Administrator conducted a physical plant tour at 1:50PM, and no immediate concerns were observed. The following was then determined:

Allegation: “Staff did not prevent a resident from threatening another resident”

It was reported that facility staff did not prevent Resident #1 (R1) from verbally harassing and threatening other residents, despite having prior knowledge of the behavior. On 06/26/2026, the Department also received an incident report from the facility stating that R1 and Resident #2 (R2) engaged in a verbal conflict in the hallway. According to the report, both residents exchanged insulting comments, and staff quickly intervened and redirected the residents.

R1 confirmed the incident and stated that the conflict began after R2 bent over and exposed themself in the hallway. R1 reported that they generally get along with all residents except R2, who R1 believes frequently instigates issues. R2 reported that R1 often makes “nasty” comments and death threats toward them. R2 stated they do not cause issues unless provoked; however, they confront R1 because they will not tolerate insults or threats. R2 confirmed that conflicts occur primarily in the hallway during passing interactions and stated that staff respond by redirecting and separating residents.

Interviews with staff revealed that the statements provided by R1 and R2 about the 06/26/2026 incident were inconsistent, and the facility issued R1 a warning regarding house rules. Staff reported that R2 frequently instigates conflict among residents and that R1 and R2 often exchange insults. Staff denied additional issues involving other residents or reports of R1 making threats.

Report Continued on LIC 9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2026

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20260708103856

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: INN AT THE PARK VENTURA	FACILITY NUMBER: 195850339
	VISIT DATE: 08/26/2026

NARRATIVE

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A review of R1’s Appraisal/Needs and Services Plan dated 03/06/2026 showed no concerns related to socialization, emotional, or mental health needs. R2’s Appraisal/Needs and Services Plan dated 06/13/2026 documented a pattern of instigating problems among residents, a history of outbursts toward residents and staff, and frequent claims of harassment without providing additional details.

Based on interview and record review, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur; therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2026

LIC9099 (FAS) - (06/04)

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