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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610252
Report Date: 12/03/2025
Date Signed: 12/03/2025 01:22:33 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.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
12/02/2025 and conducted by Evaluator Leslie Ngo-Castaneda
COMPLAINT CONTROL NUMBER: 31-AS-20251202095811
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:
12/03/2025
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Lora Pana- Assistant AdministratorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff refused to provide assistance to client in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced initial complaint visit to this facility to investigate the above allegations. LPA met with assistant administrator Lora Pana and explained the purpose of the visit.

Allegation: Staff refused to provide assistance to the client in care

It was alleged that the staff refuse to provide assistance to client #1 (C1) after having soiled themselves. Upon LPA arrival, it was observed that C1 was not at the facility.

To investigate the allegation, at 8:40 AM LPA conducted a physical plant tour to ensure the health and safety of the clients in care. LPA requested documents at 8:45 AM, interviewed two (2) out of four (4) clients from 8:45 AM to 9:00 AM and five (5) staff from 11:00 AM to 11:40 AM.
Continue to LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025
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-20251202095811
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: 12/03/2025
NARRATIVE
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During the physical plant tour, LPA observed at least five (5) staff providing care and supervision to the clients at the facility. A review of C1's physician report and IPP documents states C1 is completely independent and does not need any assistance with personal care, bathing, grooming, walking, feeding and changing. Interviews with both the assistant administrator and staff, held between 11:00 AM to 11:40 AM do not corroborate the allegation. Interview held with two (2) of four (4) clients, made between 8:45 AM to 9:00 AM revealed no complaints or concerns with assistance, care, and supervision provided by facility staff. Clients receive all the assistance with ADLs from staff based on their own ability and denied having issues receiving assistance when they need it or ask for it. Previously, on 11.12.25 LPA reviewed C1's physician's report, IPP, and was witness to NLACRC meeting. Information received revealed that C1 has the full capacity for self-care and wants full independence with no physical touch from staff.

Based on interviews, observations, record review 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.

Exit interview conducted. A copy of the report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2