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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609303
Report Date: 04/03/2025
Date Signed: 04/03/2025 03:46:54 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
03/24/2025 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20250324092718
FACILITY NAME:TWIN OAKS GUEST HOME LLCFACILITY NUMBER:
197609303
ADMINISTRATOR:AKAHOSHI, TAMIFACILITY TYPE:
740
ADDRESS:3246 HONOLULU AVETELEPHONE:
(818) 249-3107
CITY:LA CRESCENTASTATE: CAZIP CODE:
91214
CAPACITY:6CENSUS: 4DATE:
04/03/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:TAMI AKAHOSHI- AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Insufficient Staff to meet resident’s needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced initial complaint visit for the above allegation. LPA arrived and met with the Adminisistrator Tami Akahoshi and explained the reason for the visit. LPA requested copies of pertinent information which includes and not limited to LIC 500,Resident Roster, Resident #1(R1) Admission Agreement, Physician Report, Appraisal Needs and Services. LPA conducted a physical plan tour, to ensure health and safety of the residents are protected and are in compliance with Title 22 Regulations. Today's investigation consisted of interviews with 4 out of 4 residents, 2 staff members and record review.

Allegation: Insufficient Staff to meet resident’s needs.
It was alleged that the facility had insufficient staff to meet Resident#1's (R1) needs. Interview with Staff#1 (S1) denies the allegation. S1 stated that there are enough staff to assist with the dependent residents at the facility. S1 mentioned that Resident#1 (R1) had multiple falls due to R1's weakened knees. S1 confirmed calling R1's family member to assist in lifting R1. (Continue on 9099 C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
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 4
Control Number 31-AS-20250324092718
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: TWIN OAKS GUEST HOME LLC
FACILITY NUMBER: 197609303
VISIT DATE: 04/03/2025
NARRATIVE
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LPA reviewed Staff Roster (LIC 500) and observed insufficient staff are working at the facility. Based on information information obtained the allegation is deemed Substantiated at this time.


Exit interview conducted, citation issued, appeal rights given and copy of this report delivered.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20250324092718
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: TWIN OAKS GUEST HOME LLC
FACILITY NUMBER: 197609303
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/08/2025
Section Cited
CCR
87411(a)
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Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by:
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Administrator will email LPA LIC500 showing adequate staff coverage by the POC date.
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Based on interviews the facility does not have adequate staff to care for residents. This pose a potential health & safety risk to the residents 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: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4