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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610252
Report Date: 11/12/2025
Date Signed: 11/12/2025 12:13:58 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.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
11/05/2025 and conducted by Evaluator Leslie Ngo-Castaneda
COMPLAINT CONTROL NUMBER: 31-AS-20251105160654
FACILITY NAME:FORBES HOMEFACILITY NUMBER:
197610252
ADMINISTRATOR:LUCKY PANAFACILITY TYPE:
735
ADDRESS:9608 FORBES AVE.TELEPHONE:
(626) 926-7186
CITY:NORTHRIDGESTATE: CAZIP CODE:
91343
CAPACITY:4CENSUS: 4DATE:
11/12/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lucky Pana- AdministratorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff does not treat client with respect.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Leslie Ngo-Castaneda conducted an initial complaint visit to the facility to investigate the above allegation. LPA met with the administrator, Lucky Pana, and advised them about the visit. At 10:00AM LPA conducted a physical plant tour to ensure the health and safety of the clients in care.

An entrance interview was conducted.

Allegation: Staff does not treat client with respect

It was alleged that Staff #1 (S1) was asked to buy cigarettes for client #1 (C1), and in Tagalog, staff stated, "This fat-ass doesn't need cigarettes".

Continue to LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2025
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-20251105160654
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: FORBES HOME
FACILITY NUMBER: 197610252
VISIT DATE: 11/12/2025
NARRATIVE
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To investigate the allegation, on 11.13.2025, LPA interviewed five (5) staff from around 10:32 AM to 12:00 PM and three (3) out of four (4) clients from around 10:51 AM- 11:45AM. During interviews with staff, all staff stated they always treat clients with respect and dignity. Staff #1 (S1) added that they would never said/ called ‘fat-ass’ to any of the clients.

LPA interviewed C1 at 11:48 AM and asked a question in Tagalog, but C1 translated it incorrectly and did not understand what LPA was asking. During client interviews, two (02) of three (03) clients stated that staff treat them with dignity and respect. Interviews with clients revealed that they are happy and have not experienced such treatment from staff.

Based on observations and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted during the visit.

An exit interview was conducted, and a copy of the report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2