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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609488
Report Date: 08/17/2026
Date Signed: 08/17/2026 05:20:31 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 Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20250424114506
FACILITY NAME:LIVELY HOME CAREFACILITY NUMBER:
197609488
ADMINISTRATOR:TOPACIO, MARFIEBETHFACILITY TYPE:
740
ADDRESS:44328 LIVELY AVETELEPHONE:
(661) 945-5376
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:6CENSUS: 3DATE:
08/17/2026
UNANNOUNCEDTIME BEGAN:
02:38 PM
MET WITH:Marfibeth Topacio - AdministratorTIME COMPLETED:
05:35 PM
ALLEGATION(S):
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Staff did not follow reporting requirements.
Resident was required to purchase hygiene supplies.
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) Evelin Rios conducted a subsequent unannounced complaint investigation visit regarding the above allegations. LPA met with two (2) staff in the facility and explained the reason for the visit. Staff contacted the administrator to inform them LPA was at the facility. LPA met with the administrator shortly after.

The investigation consisted of the following: On 04/30/25 LPA Rios conducted an unannounced initial complaint investigation visit. During the visit LPA requested a copy of the Register of Facility Residents (LIC9020) and Personnel Report (LIC500). LPA Rios conducted a physical plant tour of the facility inside and out. While conducting the physical plant tour LPA attempted to interview two (2) of three (3) residents. The two (2) residents did not respond to LPA's questions. LPA was able to interview one (1) of three (3) residents. LPA Rios reviewed and obtained copies of relevant documents to the investigation such resident's Medical Assessment, Appraisals, Unusual Incident Report and Admission Agreement. During today's visit LPA delivered findings. (Cont. to LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2026
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 6
Control Number 31-AS-20250424114506
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: LIVELY HOME CARE
FACILITY NUMBER: 197609488
VISIT DATE: 08/17/2026
NARRATIVE
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The investigation revealed the following:

Regarding the allegation: Staff did not follow reporting requirements. It is alleged staff did not submit an incident report for a fall sustained by Resident#1 (R1) on 2/12/25. Interviews with staff revealed staff notified the administrator regarding the incident and administrator is in charge of submitting incident report, notifying responsible party, and physician. Administrator stated they had submitted an incident report to the Department. Documents reviewed revealed incident report dated 2/12/25 was received by the Department on 2/26/25 notes, R1 was found in their bedroom floor after they yelled they “were falling”. Although the administrator submitted an incident report to the Department it was received after 14 days of the incident occurring. Therefore, the allegation is substantiated.

Based on LPAs observations, interviews conducted , and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

Regarding the allegation: Resident was required to purchase hygiene supplies. It is alleged staff requested responsible party purchase toilet paper for resident. Interview with one (1) resident and their responsible party revealed facility’s administrator had required them to purchase toilet paper for the resident’s use. Interview with the administrator revealed that they had been providing toilet paper to R1 and continued to do so. They only asked R1’s responsible party to also provide toilet paper because R1 was using an increased amount. According to the Admission Agreement signed on 12/3/24 it notes R1 will receive basic services which include hygiene items of general use. Admission agreement does not include a clause to charge fees or require residents to provide their own toilet paper if additional toilet paper is necessary. Therefore, the allegation is substantiated.

Based on LPAs observations, interviews conducted , and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

Deficiencies cited on LIC9099-D. Appeal Rights and report provided to administrator.
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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 Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20250424114506

FACILITY NAME:LIVELY HOME CAREFACILITY NUMBER:
197609488
ADMINISTRATOR:TOPACIO, MARFIEBETHFACILITY TYPE:
740
ADDRESS:44328 LIVELY AVETELEPHONE:
(661) 945-5376
CITY:LANCASTERSTATE:CAZIP CODE:
93536
CAPACITY:6CENSUS: 3DATE:
08/17/2026
UNANNOUNCEDTIME BEGAN:
02:38 PM
MET WITH:Marfibeth Topacio - AdministratorTIME COMPLETED:
05:35 PM
ALLEGATION(S):
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Staff neglect resulted in a resident sustaining an injury.
Staff left resident in bed for an extended period of time.
Staff did not ensure medication cabinet was locked.
Staff did not provide activities for residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) Evelin Rios conducted a subsequent complaint investigation visit regarding the above allegations. LPA met with two (2) staff in the facility and explained the reason for the visit. Staff contacted the administrator to inform them LPA was at the facility. LPA met with the administrator shortly after.

The investigation consisted of the following: On 04/30/25 LPA Rios conducted an unannounced initial complaint investigation visit. During the visit LPA requested a copy of the Register of Facility Residents (LIC9020) and Personnel Report (LIC500). LPA Rios conducted a physical plant tour of the facility inside and out. While conducting the physical plant tour LPA attempted to interview two (2) of three (3) residents. The two (2) residents did not respond to LPA's questions. LPA was able to interview one (1) of three (3) residents. LPA Rios reviewed and obtained copies of relevant documents to the investigation such resident's Medical Assessment, Appraisals, Unusual Incident Report, Admission Agreement, R1's discharge paperwork, Activity List. During today's visit LPA delivered findings. (Cont. to LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 31-AS-20250424114506
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: LIVELY HOME CARE
FACILITY NUMBER: 197609488
VISIT DATE: 08/17/2026
NARRATIVE
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The investigation revealed the following:

Regarding the allegation: Staff neglect resulted in a resident sustaining an injury. It is alleged that R1 fell out of bed because the facility did not obtain bed rails or provide adequate supervision, resulting in the fall. Interview with one (1) resident reveled staff assist them as needed and they have not experienced any falls in the facility. The administrator reported that R1’s bedroom door is a required fire door that must remain closed because it does not automatically close when the smoke alarms go on therefore, R1 was provided a call button. Staff interviews revealed they conduct regular check-ins with residents every 1–2 hours. Staff present during the incident stated approximately one hour had passed between the last check in on R1 and when they heard R1 yell they were falling. Staff went to R1's bedroom and observed R1 on the floor on their rear end. R1 had initially stated they were ok but once assisted to the bed they complained about pain and staff contacted the administrator, R1's responsible party and 911. The administrator stated R1 often wrapped themselves in blankets, making it difficult for them to get out of bed. The administrator also confirmed that they received a request for a bed rail and had requested a physician’s order days prior to the fall. The facility did not have a physician’s order for a bed rail, prior to R1's fall. Although R1 sustained a fracture requiring surgery, there were no other documented falls, and there is not sufficient evidence to show that staff failed to provide appropriate assistance with supervision. Therefore, the allegation is unsubstantiated.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding allegation: Staff left resident in bed for an extended period of time. It is alleged R1 is left in bed as staff do not know how to transfer them from bed to wheelchair. Interview with one (1) resident revealed staff assist them as needed and are not left in bed for an extended period of time. Interviews with staff revealed R1 sustained a fracture on 2/12/25 upon returning to the facility on 4/10/25, R1’s mobility changed and required assistance to transfer from bed to wheelchair. Before the fall R1 was able to use a walker to ambulate. Due to the change in condition R1 spent more time in their bed than before. Review of Skilled Nursing Order Summary Report dated: 4/7/25 revealed R1 had a fracture to the neck of right femur. There were no physician’s orders or summary reports regarding care upon return to the facility. Staff interviewed, stated R1 was transferred to wheelchair to have breakfast in the dining area and R1 was able to communicate with staff about when they wanted to be transferred out of bed. (Continue to LIC9099-C)
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 31-AS-20250424114506
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: LIVELY HOME CARE
FACILITY NUMBER: 197609488
VISIT DATE: 08/17/2026
NARRATIVE
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Even though R1 may have been spending more time in their bed there is not enough evidence to say staff were not assisting R1 with transfer assistance or with ambulating. Therefore the allegation is unsubstantiated.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation: Staff did not ensure medication cabinet was locked. It is alleged medication cabinet was observed unlocked. On 04/30/25, LPA Rios inspected the cabinet and drawers where medications are centralized, and observed all storage areas to be locked at the time of inspection. An interview with one (1) resident indicated they had not seen the medication cabinet left unlocked at any time. Interviews with staff revealed that the medication cabinet is always maintained locked until medications are being prepared or administered. The administrator stated staff are trained on medication storage procedures and understand that medications must be locked. Record review did not show any prior deficiencies indicating that the medication cabinet had been left unlocked. Therefore, the allegation is unsubstantiated.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation: Staff did not provide activities for residents in care. It is alleged there are no activities available for the residents. Interview with one (1) resident revealed they are asked to participate in activities. Interviews with staff and the administrator indicated that following R1’s fall, staff provided activities such as arm exercises, coloring, playing piano, and playing cards. According to staff, R1 did not have an activity schedule but chose activities based on their mood. Staff reported that R1 liked playing checkers with a friend and would be transferred to a wheelchair and taken to the living room when participating in activities. Staff and the administrator stated activities are offered and available, and residents are encouraged to participate based on their abilities and preferences. LPA observed supplies for in the facility to conduct activities and reviewed the facility's activity list. Based on interviews and observations, there is insufficient evidence to show that staff failed to provide activities for residents in care. Therefore, the allegation is unsubstantiated.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted copy of report provided to administrator.
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 31-AS-20250424114506
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: LIVELY HOME CARE
FACILITY NUMBER: 197609488
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2026
Section Cited
CCR
87211(a)(1)
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Reporting Requirements 87211(a) Each licensee shall furnish to the licensing agency such reports as the Department may require ... (1)A written report shall be submitted to the licensing agency... within seven days of the occurrence ... This requirement is not met as evidenced by:
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Administrator will review the regualtion cited and a written statement of understanding will be completed and submitted to the Department by POC due date 08/28/26.
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Based on interviews conducted with staff, the licensee did not comply with the section cited above in which R1 had a fall causing serious injury and the facility did not report the inicident to the Department timely which poses a potential health, and safety or personal rights risk to residents in care.
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Type B
08/28/2026
Section Cited
CCR
87307(a)(3)(D)
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Personal Accommodations and Services 87307(a) ...The following provisions shall apply: (3) ... supplies necessary for personal care ... shall be readily available to each resident. ... the licensee shall assure provision of: (D) Hygiene items ... such as soap and toilet paper.
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Administrator will review the regualtion cited and a written statement of understanding will be completed and submitted to the Department by POC due date 08/28/26.
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This requirement is not met as evidenced by: Based on interviews conducted with staff, the licensee did not comply with the section cited above in requesting residnets to provide own toilet paper which poses a potential health, and 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.
SUPERVISOR'S NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6