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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608711
Report Date: 11/04/2025
Date Signed: 11/04/2025 01:13:07 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
10/08/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20251008140917
FACILITY NAME:FOOTHILL RETIREMENT CARE HOMEFACILITY NUMBER:
197608711
ADMINISTRATOR:CABRERA, MARIAFACILITY TYPE:
740
ADDRESS:6720 SAINT ESTEBAN STREETTELEPHONE:
(818) 353-3350
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY:72CENSUS: 60DATE:
11/04/2025
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Georgina Osuna, Wellness DirectorTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff mishandled a resident's personal belongings
INVESTIGATION FINDINGS:
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On 11/04/25, at 8:10am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Georgina Osuna, Wellness Director. LPA explained the purpose of this visit was to gather additional information and deliver findings regarding this complaint.

On 10/10/25, LPA Jose Gary Tan conducted the initial complaint visit. On 10/10/25, LPA Jose Gary Tan obtained the following documents for the above allegations-Admission Agreement, Resident's Appraisal, Needs and Appraisal, Physican's Report and Resident Pre-Placement. On 11/04/25, LPA Saucedo asked for resident and staff rosters. On 11/04/25, At 9:05am, LPA Saucedo conducted a physical tour, conducted resident and staff interviews and delivered findings for this complaint.

LIC 9099C-continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
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 5
Control Number 31-AS-20251008140917
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: FOOTHILL RETIREMENT CARE HOME
FACILITY NUMBER: 197608711
VISIT DATE: 11/04/2025
NARRATIVE
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Regarding the allegation: Staff mishandled a resident's personal belongings. It is being alleged that Resident #1 (R1)’s medical device and clothing have been missing. During LPA’s interview with R1, R1 confirmed that their medical device was not lost at this facility but at the skilled nursing facility that they were residing in prior to coming to this facility. R1 further stated, "that some of their fall clothes have been missing since their arrival at this facility." R1 continued to say, "that things have been missing from them not only the above facility but since they have been living alone and their phone has also been hacked three (3) different times and that their purse was ransacked but no credit cards and/or money was taken from them." LPA asked staff #1 (S1) for R1’s SPV-Safeguards for property/valuables. LPA compared all property to R1's property and it was all there. LPA interviewed five (5) other residents that confirmed they have not had any issues with their personal belongings including R1's roommate. LPA interviewed three (3) staff that confirmed they have never taken anything from R1 and/or any other residents. Therefore, based on the LPA's observations, staff and resident interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the Wellness Director.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
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
10/08/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20251008140917

FACILITY NAME:FOOTHILL RETIREMENT CARE HOMEFACILITY NUMBER:
197608711
ADMINISTRATOR:CABRERA, MARIAFACILITY TYPE:
740
ADDRESS:6720 SAINT ESTEBAN STREETTELEPHONE:
(818) 353-3350
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY:72CENSUS: 60DATE:
11/04/2025
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Georgina Osuna, Wellness DirectorTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff are mishandling a resident's medications
INVESTIGATION FINDINGS:
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On 11/04/25, at 8:10am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Georgina Osuna, Wellness Director. LPA explained the purpose of this visit was to gather additional information and deliver findings regarding this complaint.

On 10/10/25, LPA Jose Gary Tan conducted the initial complaint visit. On 10/10/25, LPA Jose Gary Tan obtained the following documents for the above allegations-Admission Agreement, Resident's Appraisal, Needs and Appraisal, Physican's Report and Resident Pre-Placement. On 11/04/25, LPA Saucedo asked for resident and staff rosters. On 11/04/25, At 9:05am, LPA Saucedo conducted a physical tour, conducted resident and staff interviews and delivered findings for this complaint.

LIC 9099C-continued
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20251008140917
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: FOOTHILL RETIREMENT CARE HOME
FACILITY NUMBER: 197608711
VISIT DATE: 11/04/2025
NARRATIVE
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Regarding the allegation: Staff are mishandling a resident's medications. It is being alleged that Resident #1-(R1)’s medication is not being provided at the correct time and that the staff are not monitoring their diabetes. Let it be noted, R1’s admission to the above facility was on 08/18/25 and their medication was transferred on 08/21/25. LPA asked for R1's MAR-Medication Administration Record and it was determined by reviewing R1's MAR, medication was not being administered everyday for the months of August, September and October. Some of the medication that was not being administered was their diabetes medication. R1 did confirm that their medication is now being provided to them everyday. Although, LPA interviewed five (5) residents that confirm their medication is being provided to them everyday, R1's medication was not being provided at prescribed times. In addition, two (2) staff did confirm that they do not know if the medication was provided or not since it is not documented on R1's MAR. Therefore, based on the LPA's observations, staff and resident interviews, the above allegation(s) above is SUBSTANTIATED at this time.

An exit interview was conducted, citation(s) were issued, an appeals right was provided and a copy of this report was given to the Wellness Director.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20251008140917
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: FOOTHILL RETIREMENT CARE HOME
FACILITY NUMBER: 197608711
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/26/2025
Section Cited
CCR
87411(d)(4)
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Personnel Requirements: All personnel shall be given on the job training or have related experience with knowledge required to safely assist with prescribed medications. This requirement was not met as evidenced by:
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The Administrator/Licensee shall conduct an in-service training to all staff regarding medication.

POC 11/26/25
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Based on LPA's observation and interviews, the licensee/administrator did not comply with the section cited above by providing R1 their medicaiton everyday and/or when prescribed which posed a potential Health, Safety, or Personal Rights risk to persons in care.
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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: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5