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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609782
Report Date: 06/24/2026
Date Signed: 06/24/2026 02:55:24 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
06/17/2026 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20260617080900
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: 5DATE:
06/24/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Carrie AcostaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff yelled at a resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint investigation visit at the facility at 10:15 AM. LPA met with facility staff who contacted the Administrator Carrie Acosta via telephone call. The Administrator arrived to the facility at 10:30 AM entrance interview was conducted and the reason for the visit was explained.

During today’s visit LPA conducted a brief physical plant tour and conducted interviews with the Administrator, two (2) staff, one (1) witness, and four (4) residents between 10:20 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: 06/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2026
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 3
Control Number 29-AS-20260617080900
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: 06/24/2026
NARRATIVE
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The allegation of “Staff yelled at a resident.” Alleges that the facility Administrator raised their voice and spoke inappropriately towards facility residents. Two (2) residents interviewed stated that the facility Administrator had raised their voice to an inappropriate level when speaking with them in the past. Residents reported that the Administrator raised their voice and shouted things like “If you don’t like it, you can get out of here!” when informing the Administrator that they did not like something about the facility and “Can’t you just wait!” when asking the Administrator for something. LPA interviewed two (2) staff members. Both staff members stated that previous residents had informed them in the past that they were spoken to inappropriately by the facility Administrator. Both staff members denied ever personally witnessing the Administrator speaking inappropriately towards facility residents. LPA interviewed one (1) witness who stated that they had been informed by a facility resident that the Administrator had spoken to the resident inappropriately but denied personally witnessing the Administrator ever speaking inappropriately towards facility residents. LPA interviewed the Administrator who denied ever speaking inappropriately towards residents but stated that they understand that their voice may be interpreted as having a harsh tone. Based on the information obtained during interviews there is sufficient evidence to support the allegation of “Staff yelled at a resident.” Therefore, the allegation is deemed Substantiated at this time.

The Administrator had to leave the facility at the time of the visit but has designated facility staff to sign this report on their behalf. This report was read to the Administrator via telephone call. The following deficiency was cited (refer to LIC 9099D). A copy of the report was printed, appeal rights were provided, and exit interview was conducted.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20260617080900
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: 06/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/08/2026
Section Cited
CCR
87468.1(a)(1)
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87468.1 Personal Rights of Residents...
(a) ... shall have all of the following personal rights:
(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.
This requirement is not met as evidenced by:
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Administrator agreed to attend training which covers the personal rights of residents and the different forms of abuse conducted by an outside agency not associated to the facility. Administrator agreed to submit proof of the completed training to CCLD no later than POC due date.
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Based on interviews the Licensee did not comply with the section cited above as two residents reported that the Administrator had spoken inappropriately towards them in the past which poses a potential personal rights risk to clients 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: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3