197608120-5-5-2026-31-AS-MGFS-DU2NN4-20260513103605

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608120
Report Date: 05/05/2026
Date Signed: 05/05/2026 02:35:27 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
03/05/2026 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20260305115104

FACILITY NAME:	CCLE HOME CARE, LLC		FACILITY NUMBER:	197608120
ADMINISTRATOR:	ROSANNA TOMENENG		FACILITY TYPE:	735
ADDRESS:	16055 NAPA STREET		TELEPHONE:	(818) 830-7383
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	4	CENSUS: 4	DATE:	05/05/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Josephine Dangzalan- Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff retaliated against resident for filing a complaint.
Staff yelled at resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent visit for the above allegation. LPA met with staff designee (S2), Josephine Dangzalan and explained the reason for the visit.

On 3.10.2026, LPA Shahbazian took a tour of the physical plant at 10:15 AM. At 10:05 AM- 11:10 AM, LPA Shabazian interviewed the licensee (S1) and administrator (S2). On 5.5.2026 LPA Ngo-Castaneda requested clients records and received copies for physician's report, admission agreement, LIC 500 (staff roster), resident roster, Individual Program Plan (IPP), and other pertinent documents. On 5/5/26 LPA Ngo-Castaneda conducted a subsequent visit to deliver findings.

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: 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)

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Control Number 31-AS-20260305115104

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: 05/05/2026

NARRATIVE

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Allegation: Staff retaliated against client for filing a complaint.

It is alleged that staff did not provide meals as retaliation for filing a complaint. During today’s visit, LPA Ngo-Castaneda conducted a physical plant and interviewed two (2) out of four (4) clients at 11:42 AM. It was reported that the staff was retaliating against a client for filing a complaint. Clients interviewed by LPA reported that they have not experienced any retaliation from staff. Per clients, meals have not been denied, and they have been provided with their three (3) meals a day, with snacks in between when requested. Clients stated that the staff are nice and very helpful. Staff interviewed denied retaliating against any client for filing a complaint. Meals are provided three (3) times a day following the facility menu for everyone, and snacks are given when requested/ offered.

Based on interviews and observations, there is insufficient evidence to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Allegation: Staff yelled at client.

It is alleged that S2 yelled at a client when the client answered the front door. Interview with two (2) staff members revealed that they do not yell at the clients. On 5/5/2026, LPA Ngo-Castaneda interviewed two (2) out of four (4) clients expressed no concerns regarding this allegation and confirmed that staff communicate appropriately speak to them cordially and respectfully. Clients reported that a client at the facility yells and causes disturbances. However, staff de-escalate the situation by speaking calmly, redirects the clients, and give the clients some space. During today’s visit LPA observed staff treating clients in a professional and respectful manner. LPA called and spoke to W1 at 12:16 PM and stated that they did not heard/ witness S2 yelling at clients at the facility and that the allegation is completely false.

Therefore, based on interviews and observation, this allegation is deemed Unsubstantiated, at this time.

No health and safety issues noted at the time of this visit.

An exit interview was conducted, and a copy of the report was provided.

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
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)

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