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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608611
Report Date: 03/14/2024
Date Signed: 03/14/2024 12:49:24 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
03/05/2024 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20240305140645
FACILITY NAME:ESTAR RESIDENTIAL CAREFACILITY NUMBER:
197608611
ADMINISTRATOR:ARNALDO A. HUKOMFACILITY TYPE:
740
ADDRESS:8559 BOTHWELL ROADTELEPHONE:
(818) 727-1953
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:6CENSUS: 2DATE:
03/14/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:ARNALDO HUKOM- Administrator TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Licensee did not notify CCL of a sale of the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA granted access by Staff 1 (S1) and Administrator arrived shortly after. At 10:15 AM LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. LPA requested and obtain copies of LIC 500, Resident Roster, Administrator Certificate.
Allegation: Licensee did not notify CCL of a sale of the facility
It was alleged that Licensee had sold the facility to S1 in February 2024 without notify CCL. LPA interviewed S1 who had been introduced to the LPA as the House Manager. Interview with S2 revealed that S2 had sold the facility to S1 since February 9, 2024. S2 stated that they are currently the facility Administrator until S1 applies for the License. S2 confirmed that they haven't applied for License and had bought the facility in February 9, 2024. S2 admitted that they have failed to notify resident's responsible party in written and CCL regarding the sale of the facility.
(Continue on 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024
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 31-AS-20240305140645
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ESTAR RESIDENTIAL CARE
FACILITY NUMBER: 197608611
VISIT DATE: 03/14/2024
NARRATIVE
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Although property will remain as a licensed facility, and continue to operate as a licensed facility,
the licensee should have informed the department of the event of a sale, and submitted their intentions to the department in writing. Therefore, the above allegation is substantiated. Exit interview conducted, citation issued and copy of this report delivered.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 31-AS-20240305140645
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ESTAR RESIDENTIAL CARE
FACILITY NUMBER: 197608611
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2024
Section Cited
HSC
1524.1(a)(1)
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Health & Safety 1524.1(a)(1)The licensee shall provide written notice to the department and to each resident or client or his or her legal representative of the licensee's intent to sell the facility at least 60 days prior to the transfer of property or business, or at the time that a bona fide offer is made, whichever period is longer.
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The licensee submitted written notification to CCL and resident's responsible party regarding the sale of the facility on 3/14/2024.
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Licensee failed to notify CCL and resident's responsible party in writing regarding the sale of the facility 60 days prior to the transfer of property or business.
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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: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3