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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608120
Report Date: 03/04/2026
Date Signed: 03/04/2026 03:41:05 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
03/03/2026 and conducted by Evaluator Leslie Ngo-Castaneda
COMPLAINT CONTROL NUMBER: 31-AS-20260303083957
FACILITY NAME:CCLE HOME CARE, LLCFACILITY NUMBER:
197608120
ADMINISTRATOR:ROSANNA TOMENENGFACILITY TYPE:
735
ADDRESS:16055 NAPA STREETTELEPHONE:
(818) 830-7383
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:4CENSUS: 4DATE:
03/04/2026
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Josephine Dangzalan- designeeTIME COMPLETED:
03:38 PM
ALLEGATION(S):
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Facility is in disrepair.
Staff made inappropriate comments to residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Leslie Ngo-Castaneda and Angelica Segovia conducted an initial complaint visit to the facility to investigate the above allegation. LPAs met with the staff desgnee, Josephine Dangzalan, and advised them about the visit.

At 10:40 AM LPAs conducted a physical plant tour to ensure the health and safety of the clients in care. LPA interviewed four (4) clients and two (2) staff from 10:44 AM to 12:00 PM. At 12:30 PM, LPA reviewed and received copies of documents pertaining to the investigation: staff roster (LIC 500), resident roster (LIC 9020), physician report, identification and emergency information, IPPs, and incident reports.

Allegation #1: Facility is in disrepair.

Continue to LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
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-20260303083957
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: CCLE HOME CARE, LLC
FACILITY NUMBER: 197608120
VISIT DATE: 03/04/2026
NARRATIVE
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Regarding the allegation “Facility is in disrepair,” it was alleged that a lighter/ matches is needed to operate the kitchen gas stove and that the client’s bathroom shower knob is broken. During the physical plant tour, LPAs observed the clients bathroom shower knob to be in working order; and staff turned on the gas stove in the kitchen without using a lighter/ matches. LPAs observed that all of the facility’s equipment is in working order. During interviews with staff, all staff stated they are unaware of any common bathroom shower knob, and kitchen equipment (gas stove) being in disrepair. During the interviews with clients, all clients stated they are not aware of any common bathroom shower knob or kitchen gas stove being in disrepair.

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

Allegation #2: Staff made inappropriate comments to clients in care.

Regarding the above allegation, it is alleged that the facility staff made inappropriate comments to clients in care. During interviews with staff, all staff stated they do not make inappropriate comments to clients in care. Staff stated they treat all clients with respect and dignity. During interviews with clients, all interviewed clients stated staff do not make inappropriate comments and they are treated with respect and dignity. Clients stated that they are happy and have not experienced such comments from staff.

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

Exit interview conducted. Copy of this report given to S2.
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
LIC9099 (FAS) - (06/04)
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