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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609303
Report Date: 04/24/2025
Date Signed: 04/24/2025 01:13:17 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:
04/24/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:TAMI AKAHOSHI- AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not comply with infectious control requirements.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced subsquent complaint visit for the above allegation. LPA arrived and met with the Adminisistrator Tami Akahoshi and explained the reason for the visit. LPA conducted a physical plan tour, to ensure health and safety of the residents are protected and are in compliance with Title 22 Regulations.

Allegation: Staff did not comply with infectious control requirements.
It was alleged that staff did not comply with infectious control requirements, which led to two residents becoming sick, and one of the residents passed away. LPA conducted records review, which indicated that R3 passed away due to cardioraspitory failure. Hospital records indicated that R3 was present at USC Verdugo Hills Hospital with severe kidney pain. Interview with Staff#1(S1) revealed that S1 had symptoms of cold and did not take sick leave to prevent the spread of the disease. Although S2 mentioned that the facility had stopped group dining and activities, the facility staff did not comply with the facility's infection control plan. (Continue on 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
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 3
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: 04/24/2025
NARRATIVE
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The facility's infectious control plan indicates on page 5 that if symptoms of any kind of disease or illness appear in a staff member, the facility will enforce the sick leave restriction policy to prevent the spread of disease or illness. Based on the information obtained, the allegation is deemed substantiated at this time.

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

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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: 04/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2025
Section Cited
CCR
87465(a)(9)
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(9) The licensee shall ensure that infection control practices are maintained in the facility as specified in Section 87470, Infection Control Requirements
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Administrator will provide a statement understanding this section of California code regulation
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Based on interviwes and record review, the administrator did not comply with the section cited above. S1 had symptoms of cold and did not take sick leave to prevent the spread of the disease which poses a potential health, safety or personal rights risk to 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: 04/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3