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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610252
Report Date: 02/06/2025
Date Signed: 02/07/2025 08:50:35 AM

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
01/28/2025 and conducted by Evaluator Leslie Ngo-Castaneda
COMPLAINT CONTROL NUMBER: 31-AS-20250128092923
FACILITY NAME:FORBES HOMEFACILITY NUMBER:
197610252
ADMINISTRATOR:LUCKY JAY PANAFACILITY TYPE:
735
ADDRESS:9608 FORBES AVE.TELEPHONE:
(626) 926-7186
CITY:NORTHRIDGESTATE: CAZIP CODE:
91343
CAPACITY:4CENSUS: 4DATE:
02/06/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lucky Pana- AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff are unable to communicate with resident due to a language barrier.
Staff made false accusations about resident.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Leslie Ngo-Castaneda and Angelica Segovia conducted a initial complaint visit to the facility to investigate the above allegations. LPAs met with the administrator, Lucky Pana, and advised them about the visit. At 9:05 AM LPA conducted a physical plant tour to ensure the health and safety of the clients in care.

An entrance interview was conducted.

Allegation #1: Staff are unable to communicate with resident due to a language barrier.

It was alleged that the facility staff is unable to communicate with residents due to language barrier. It is being alleged that the client #1 (C1) mentioned that the staff do not speak English, which impedes their ability to communicate with them.
Continue to LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
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-20250128092923
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: 02/06/2025
NARRATIVE
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LPA interviewed three (3) out of four (4) residents that confirmed that there is no language barrier with the staff. All the staff can communicate with the residents and is able to speak English. LPA interviewed five (5) out of five (5) staff that confirmed they speak English well. LPA called and spoke to staff #1 (S1) at 9:38AM and LPA was able to communicate and understand S1 completely fine. It was revealed that C1 started mocking S1 accent and stated that they could not understand them because of their accent. Therefore, based on the LPA interviews, observations, and record reviews the above allegation(s) above is UNSUBSTANTIATED at this time.

Allegation #2: Staff made false accusations about resident.

Regarding the above allegation, it is alleged that the staff made false accusation/ comments towards client #1 (C1). LPA interview with five (5) staff on 2.6.2025 between 10 AM to 10:30AM. At 9:38 AM LPA called S1 to interview the allegation regarding being racists towards C1. It was revealed that C1 started mocking S1 accent and stated that C1 does not understand S1. LPA interview staff at 10AM and unanimously stated that staff did not and would never state such comments towards the clients. C1 has been working at the facility for two (2) years and no issues has arisen about them. LPA interviewed three (3) out of four (4) clients from 10:30 AM to 11AM. Interviews from clients revealed that they are happy and have not experience such treatment from staff. Interviews with staff revealed that they treat all their clients with respect and dignity.

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

An exit interview was conducted, no citations were issued for the above allegation(s), and a copy of this report was given to the executive director.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2