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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609782
Report Date: 04/15/2026
Date Signed: 06/03/2026 02:16:33 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/23/2026 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20260323103529
FACILITY NAME:CARRIES CARE VILLAFACILITY NUMBER:
197609782
ADMINISTRATOR:ACOSTA, MARK RYANFACILITY TYPE:
740
ADDRESS:12550 BURTON STTELEPHONE:
(818) 767-4503
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: 4DATE:
04/15/2026
UNANNOUNCEDTIME BEGAN:
01:29 PM
MET WITH:Carrie AcostaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Staff do not respond in a timely manner to assist resident.
INVESTIGATION FINDINGS:
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5
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9
10
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12
13
This report has been amended. Please see report issued 06/03/2026.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
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 4
Control Number 29-AS-20260323103529
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CARRIES CARE VILLA
FACILITY NUMBER: 197609782
VISIT DATE: 04/15/2026
NARRATIVE
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This report has been amended. Please see report issued 06/03/2026.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/23/2026 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20260323103529

FACILITY NAME:CARRIES CARE VILLAFACILITY NUMBER:
197609782
ADMINISTRATOR:ACOSTA, MARK RYANFACILITY TYPE:
740
ADDRESS:12550 BURTON STTELEPHONE:
(818) 767-4503
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: 4DATE:
04/15/2026
UNANNOUNCEDTIME BEGAN:
01:29 PM
MET WITH:Carrie AcostaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff using inappropriate forms of punishment.
INVESTIGATION FINDINGS:
1
2
3
4
5
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9
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13
Licensing Program Analyst (LPA) Trevor Byrne arrived to the facility at 01:29 PM to conduct a follow-up complaint investigation visit at the facility today. LPA met with facility staff who contacted the Administrator Carrie Acosta. The Administrator arrived to the facility at approximately 01:51 PM. Entrance interview was conducted and the reason for the visit was explained.

During today’s visit, the LPA conducted a brief physical plant tour, conducted a file review for one (1) resident, obtained copies of pertinent documentation, and delivered findings between 01:30 PM and 02:15 PM.

CONTINUED ON LIC 809C.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
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 4
Control Number 29-AS-20260323103529
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CARRIES CARE VILLA
FACILITY NUMBER: 197609782
VISIT DATE: 04/15/2026
NARRATIVE
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The allegation of “Staff using inappropriate forms of punishment.” alleges that facility staff left Resident #1 (R1) suspended in the Hoyer lift for forty-five (45) minutes to one (1) hour to discipline them. LPA interviewed R1 who stated that they had been suspended in the Hoyer lift for an extended period of time twice in the past. R1 stated that the last time this punishment occurred was approximately one (1) month ago. LPA interviewed other residents of the facility all of whom denied ever being placed into the Hoyer lift. No other residents interviewed observed R1 suspended in the Hoyer lift for an extended period of time. LPA interviewed facility staff #1 (S1) who stated that the last time the Hoyer lift was utilized to move R1 was approximately two (2) months ago. S1 stated that R1 was not left in the lift for more than five (5) minutes while the lift was utilized. Staff #2 (S2) stated that they do not utilize the lift without the Administrator present because they do not know how to use the lift and never received training on how to operate the lift. S2 confirmed that the lift was only utilized twice in the past. Both staff members denied R1 being left in the lift for an extended period of time and both staff denied the lift being utilized as a form of punishment. LPA interviewed the Administrator who stated that facility staff are not allowed to utilize the Hoyer lift without the Administrator present to ensure proper operation. The Administrator stated that the longest R1 had been left in the lift was approximately 10 minutes. The Administrator denied ever leaving R1 in the lift for an extended period of time. The Administrator denied ever utilizing the Hoyer lift as a form of punishment. LPA reviewed R1’s physician report and observed R1 to have a primary diagnosis of Dementia. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of “Staff using inappropriate forms of punishment.” Therefore, the allegation is deemed Unsubstantiated at this time.

A copy of the report was printed and exit interview was conducted.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4