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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608053
Report Date: 05/21/2025
Date Signed: 05/21/2025 03:28:22 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
01/06/2025 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20250106164839
FACILITY NAME:GREENWOODS RESIDENTIAL CARE, INC.FACILITY NUMBER:
197608053
ADMINISTRATOR:MARILEN M. BASAFACILITY TYPE:
735
ADDRESS:9606 GOTHIC AVETELEPHONE:
(818) 335-4143
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 5DATE:
05/21/2025
UNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:MARILEN M. BASA- AdministratorTIME COMPLETED:
03:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff hit client
Staff did not follow reporting requirements
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mariana Agban conducted unannounced subsequent complaint visit to include additional interviews for the Substantiated complaint report on 1/15/25. LPA met with Administrator Marillen Basa and explained the reason for the visit. LPA conducted a physical plan tour, to ensure health and safety of the residents are protected and is in compliance with Title 22 Regulations. During today's visit, LPA interviewed 5 out of 5 residents. The allegations remain Substantiated.

Exit interview conducted, copy of this report delivered.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
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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