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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609303
Report Date: 04/28/2025
Date Signed: 04/28/2025 02:04:00 PM

Substantiated


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
04/24/2025 and conducted by Evaluator Antonia Alvizar-Ettima
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250424083805
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: 1DATE:
04/28/2025
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Licensee/Administrator, Tami AkahoshiTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Licensee did not follow facility closure procedures.
INVESTIGATION FINDINGS:
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At 10:35a.m., Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced initial visit to investigate the above stated allegation. LPA noticed a note on the door and contacted Licensee/Administrator via-phone and indicated they were out visiting other facilities and current heading back to the facility. At approximately 11:20a.m. LPA met with the Licensee/Administrator and explained the reason for the visit.

At about 11:30a.m., LPA Alvizar-Ettima requested the closure notice, staff and residents roster, as well as the rosters for residents that had already moved out. At 11:40a.m., LPA and Licensee/Administrator conducted physical plant tour. Between 12:00- 12:20p.m., LPA conducted interviews with resident (R1) and Licesee/Adminstrator. LPA Alvizar- Ettima asked questions relevant to the nature of the complaint. In addition, LPA reviewed available rosters for facility residents and already moved out residents.

Licensee did not follow facility closure procedures.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025
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-20250424083805
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: TWIN OAKS GUEST HOME LLC
FACILITY NUMBER: 197609303
VISIT DATE: 04/28/2025
NARRATIVE
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It was alleged that the facility is closing without giving the residents a 60 days written notice. Prior to this visit on 04/25/2025 at 1:10pm, LPM Naira Margaryan spoke with the Licensee/Administrator, Tami Akahoshi and verified that facility is closing due to sell of the property. Licensee indicated that had no knowledge that Licensing Office must be notified about facility closure and had to follow specific procedures for facility closure.

At the time of visit, Licensee/Administrator revealed the same information. LPA was informed that residents received verbal notice of closure on 04/04/25. Licensee/Administrator informed LPA that a 60 day closure notice was drafted and a copy was issued to one (01) of the residents on 04/25/25 and on 04/26/25 the other three (03) residents received the notices.

During this visit three (03) out of four (04) residents were already relocated. Resident (01) interviewed revealed that staff did provide a 60 days notice. At approximately 11:00a.m., LPA Alvizar- Ettima contacted relocated sites to verify that three (03) residents have been relocated to the sites identified by the Licensee/Administrator.

Based on inspection, observation, interviews and record review there is enough supporting information to verify the allegation. Therefore, the allegation is Substantiated.

Licensee/Administrator was informed to contact Licensing Office to provide relocation information of the resident that is still at the facility.

Under the Health and Safety Code 1569.682 the following deficiency were cited and recorded on LIC 809D.

No health and safety hazard were noted during this visit.

Exit interview is conducted. Copy of report was issued to the Licensee/Administrator.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250424083805
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: TWIN OAKS GUEST HOME LLC
FACILITY NUMBER: 197609303
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2025
Section Cited
HSC
1569.682(a)(2)
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Transfer of resident upon forfeiture of license or change in use of facility... closure plan...(a)...shall, prior to transfe-
rring a resident ... (2) Provide each resident or the responsible person with a written notice no later than 60 days before the intended eviction.
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Licensee/Administrator is now aware of the requirement to give residents a 60 day closure notices.
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Based on interview Licensee/Administrator informed LPM Margaryan and LPA Alvizar-Ettima that a 60 day closure notice was drafted and a copy was issued to one (01) of the residents on 04/25/25 and on 04/26/25 the other three (03) residents received the notices.
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POC cleared upon contact with LPM Margaryan and LPA Alvizar-Ettima Licensee/Administrator made the corrections by creating closure notice corrections & added eviction clause to the 60 day notice dated 04/25/25
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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: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3