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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609935
Report Date: 06/16/2026
Date Signed: 06/17/2026 05:07:33 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
01/06/2026 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20260106154125
FACILITY NAME:LAKESIDE VIEW ELDERLY CAREFACILITY NUMBER:
197609935
ADMINISTRATOR:DUENAS, RALPHFACILITY TYPE:
740
ADDRESS:14003 LAKESIDE STTELEPHONE:
(818) 288-5869
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:6CENSUS: 6DATE:
06/16/2026
UNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Emiliano Siapno - AdministratorTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Resident sustained injuries due to staff neglect.

Staff leave resident soiled for extended periods of time resulting in resident developing a UTI.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with Administrator Emiliano Siapno and explained the reason for the visit.

LPA conducted physical plant tour at 9:35 AM, requested copies of facility documents relevant to the investigation at 10:03 AM, reviewed records between 10:15 AM to 11:15 AM and interviewed staff and residents between 11:15 AM to 1:30 PM. Regarding the allegation that Resident sustained injuries due to staff neglect, it was alleged that Resident #1 (R1) had bruising on own arms but not with any part of R1's body. LPA's record review revealed that R1 when R1 was hospitalized on 12/25/25 and did not have any obvious bruises prior to hospitalization. LPA's interview with R1's family member (FM) today at 1:00 PM, revealed that FM witnessed R1 being restrained by the hospital staff because R1 forcibly removed own catheter which caused the bruises on R1's wrist and arm. Further interview also revealed that FM knew that R1 did not have bruises on arm and wrist while at the facility prior to hospitalization.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
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 2
Control Number 31-AS-20260106154125
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LAKESIDE VIEW ELDERLY CARE
FACILITY NUMBER: 197609935
VISIT DATE: 06/16/2026
NARRATIVE
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(continued from LIC 9099)

Regarding the allegation that Staff leave resident soiled for extended periods of time resulting in resident developing a UTI. LPA's record review today between 10:15 to 11:15 AM revealed that there was no diagnosis of Urinary Tract Infection (UTI) on R1's hospitalization admission and discharge record. LPA's interview with FM also revealed that FM witnessed facility staff never left R1 soiled for long and saw staff changing and checking R1's diaper while at the facility all the time. LPA's interview with four (4) incontinent residents today between 11:15 to 1:30 PM revealed that four (4) out of four (4) residents interviewed stated that they are regularly checked and changed by staff 3x to 5x a day including nights and did not witness any resident being left soiled for any period of time.

Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2