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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607575
Report Date: 05/05/2026
Date Signed: 05/05/2026 02:48:45 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
04/27/2026 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20260427105806
FACILITY NAME:TOLUCA LAKE MANOR SENIOR ASSISTED LIVING LLCFACILITY NUMBER:
197607575
ADMINISTRATOR:MARIANA ROMANOFACILITY TYPE:
740
ADDRESS:4560 CARTWRIGHT AVE.TELEPHONE:
(818) 232-7338
CITY:TOLUCA LAKESTATE: CAZIP CODE:
91602
CAPACITY:6CENSUS: 5DATE:
05/05/2026
UNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Mariana RomanoTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not prevent resident in care from leaving the facility without supervision
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint visit to investigate the above allegation. LPA arrived to the facility at 10:16 AM. LPA met with facility staff who contacted the Administrator Mariana Romano. Entrance interview conducted and the reason for the visit was explained.

During today's visit LPA conducted a brief physical plant tour, conducted interviews with one (1) resident, two (2) staff members, the Administrator, and collected copies of pertinent documentation between approximately 10:16 AM and 02:30 PM.

The allegation of “Staff did not prevent resident in care from leaving the facility without supervision.” Alleges that facility staff did not provide adequate supervision to Resident #1 (R1) which resulted in R1 leaving the facility without staff supervision. Prior to the investigation LPA was provided with a video filmed on 04/26/2026 which showed R1 outside of the facility without staff supervision.Continued on 9099C.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

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

DATE: 05/05/2026
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-20260427105806
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: TOLUCA LAKE MANOR SENIOR ASSISTED LIVING LLC
FACILITY NUMBER: 197607575
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/19/2026
Section Cited
HSC
1569.312(a)
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Basic services shall at a minimum include: (a) Care and supervision as defined in Section 1569.2.
This requirement is not met as evidenced by:
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Administrator agreed to conduct a meeting with R1's responsible party to discuss the implementation of a 1:1 caregiver and/or the facility's inability to meet R1's care needs and the possibility of the issuance of a 30-day eviction notice. Administrator agreed to provide proof of the completed meeting and...
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Based on interviews, evidence provided, and file review, the licensee did not comply with the section cited above as on 04/26/2026 R1 left the facility without staff assistance which posed a potential health and safety risk to residents in care.
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... the outcome of the meeting to CCLD no later than POC due date.
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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.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

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

DATE: 05/05/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20260427105806
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: TOLUCA LAKE MANOR SENIOR ASSISTED LIVING LLC
FACILITY NUMBER: 197607575
VISIT DATE: 05/05/2026
NARRATIVE
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LPA interviewed the Administrator who stated that since the last visit, the facility has implemented 30-minute staff checks on R1. The Administrator stated that the facility has implemented a motion activated auditory alert device on the facility’s gate, but they had been experiencing issues with a tree near the gate causing false alarms due to detected motion. The Administrator stated that a gardener is scheduled to prune the tree on Saturday (05/09/2026) to diminish the number of false alarms. The Administrator stated that they were unaware that R1 had left the facility without supervision on 04/26/2026. The Administrator stated that they would speak with R1’s responsible party to discuss the implementation of a 1:1 caregiver to supervise R1. LPA interviewed facility staff who confirmed that they had implemented thirty (30) minute checks on R1 throughout the day. Additionally, staff confirmed that they had been trained to respond to auditory alerts throughout the facility. LPA interviewed R1 who stated that there are enough activities at the facility to keep them entertained including pet therapy and exercise. R1 stated that the facility walks with them through the neighborhood when they are able to. LPA reviewed R1’s resident file and observed a physician’s report dated 04/15/2026. The physician’s report indicated that R1 is unable to leave the facility unassisted. LPA informed the Administrator that they were recently cited for a violation of Health and Safety Code section 1569.312(a) on 04/08/2026. LPA informed the Administrator that since this is their second (2nd) violation of this licensing regulation within a twelve (12) month period a civil penalty in the amount of $250 is being assessed on today’s date (05/05/2026) for a repeat violation. Based on the interviews conducted, evidence submitted, and file review, there is sufficient evidence to support to the allegation of “Staff did not prevent resident in care from leaving the facility without supervision.” Therefore, the allegation is deemed Substantiated at this time.

The following deficiency was cited and civil penalty assessed (Refer to LIC 9099D). Exit interview was conducted, a copy of the report and appeal rights were provided.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

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

DATE: 05/05/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3