197609782-6-3-2026-29-AS-KLOZ-DVHMCE-20260629092926

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609782
Report Date: 06/03/2026
Date Signed: 06/03/2026 02:18:41 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 VILLA		FACILITY NUMBER:	197609782
ADMINISTRATOR:	ACOSTA, MARK RYAN		FACILITY TYPE:	740
ADDRESS:	12550 BURTON ST		TELEPHONE:	(818) 767-4503
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY:	6	CENSUS: 6	DATE:	06/03/2026
		UNANNOUNCED	TIME BEGAN:	01:31 PM
MET WITH:	Carrie Acosta		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff do not respond in a timely manner to assist resident.

INVESTIGATION FINDINGS:

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This is an amended report that supersedes the report issued under this facility on 04/15/2026. LPA arrived at the facility unannounced at 01:31 PM to issue this amended report. LPA met with facility staff who contacted the Administrator Carrie Acosta. The Administrator arrived to the facility at 01:53 PM. Entrance interview was conducted and the reason for the visit was explained.

On 04/15/2026 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. 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 the 04/15/2026 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 02:45 PM. CONTINUED ON LIC 9099C.

Substantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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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: 06/03/2026

NARRATIVE

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The allegation of “Staff do not respond in a timely manner to assist resident.” alleges that, facility staff do not respond to resident’s requests for assistance in a timely manner. LPA interviewed facility residents who expressed concerns in the amount of time it takes facility staff to respond to resident’s requests for assistance. Resident #1 (R1) stated that staff take anywhere between twenty (20) minutes to two (2) hours to respond to their requests for assistance. Resident #2 (R2) stated that they had been left in soiled diapers overnight on multiple occasions due to staff not assisting residents at night. Resident #3 (R3) was unable to provide an estimated time on how long it takes staff to assist them but reported that facility staff eventually assist them with their needs but R3 believed that staff could be faster about providing care to them. LPA interviewed two (2) facility caregivers. The caregivers interviewed stated that they respond to resident’s requests for assistance as soon as they are asked. Staff stated that their shifts end at 06:00 PM on the days they work and that the facility Administrator provides care to the residents during the night until shift start at 06:00 AM. The facility staff members stated that they do not remain at the facility after their shift ends. One (1) staff member interviewed confirmed that in the past at the start of their shift (06:00 AM) they had observed facility residents in diapers that were soiled during the night and not changed. LPA interviewed the Administrator who stated that they remain awake until 12:00 AM and that they perform checks on the residents during the night. The Administrator stated that staff are expected to check on the residents throughout the day. Based on the information obtained during interviews there is sufficient evidence to support the allegation of “Staff do not respond in a timely manner to assist resident” Therefore, the allegation is deemed Substantiated at this time.

LPA reminded the Administrator that the facility is responsible for providing basic services including appropriate care and supervision to the residents in care. The Administrator expressed understanding and agreed to conduct training with all current staff members to discuss the importance of periodic checks on the residents to ask if they need assistance. Administrator agreed to send Community Care Licensing Division (CCLD) their plan on how they would ensure adequate night supervision for residents between 06:00 PM and 06:00 AM. LPA informed the Administrator that they were recently cited for a violation of California Code of Regulations (CCR) 87464(f)(1) on 03/30/2026. LPA informed the Administrator that because they violated the same licensing regulation within a twelve (12) month period a civil penalty in the amount of $250 is being assessed on today’s date (06/03/2026).

The following deficiency was cited and civil penalty assessed (Refer to LIC 9099D). Exit interview was conducted, a copy of the report was printed, and appeal rights were provided.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026

LIC9099 (FAS) - (06/04)

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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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/03/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/03/2026 Section Cited CCR 87464(f)(1)	1 2 3 4 5 6 7	87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator conducted training with all current staff members discussing the importance of periodic checks on the residents to ask if they need assistance. Administrator sent CCLD their plan on how they will ensure adequate night supervision for residents between 06:00 PM
	8 9 10 11 12 13 14	Based on observation, record review, and interviews the licensee did not comply with the section cited above as residents were left in soiled diapers and residents requests for assistance went unanswered for extended periods of time which posed a potential health or personal rights risk to persons in care.	8 9 10 11 12 13 14	to 06:00 AM. POC Cleared.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026

LIC9099 (FAS) - (06/04)

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