197610320-5-7-2026-31-AS-MGFS-DWLRU9-20260803131930

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610320
Report Date: 05/07/2026
Date Signed: 05/07/2026 01:17:55 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
05/01/2026 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20260501121812

FACILITY NAME:	WINNETKA HOME CARE		FACILITY NUMBER:	197610320
ADMINISTRATOR:	KAPIKYAN, ANDRANIK		FACILITY TYPE:	740
ADDRESS:	19733 HEMMINGWAY ST		TELEPHONE:	(818) 434-9916
CITY:	WINNETKA	STATE: CA	ZIP CODE:	91306
CAPACITY:	6	CENSUS: 5	DATE:	05/07/2026
		UNANNOUNCED	TIME BEGAN:	08:36 AM
MET WITH:	Isaiah Phirii- staff designee		TIME COMPLETED:	01:47 PM

ALLEGATION(S):

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Staff threatened resident.
Staff did not ensure restroom was accessible to resident.
Staff does not follow resident's dietary needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced initial complaint visit to the facility to investigate the above allegation. LPA met with the staff designee (S2), Isaiah Phiri, and explained the reason for the visit. At 9:37 AM, facility administrator (S1), Andranik Kapikyan, arrived and was explained the reason for the visit.

To investigate the allegation on 05.7.2026, LPA took a tour of the physical plant at 8:40 AM. LPA requested copies of: staff roster (LIC 500), resident roster (LIC 9020), physician report, admission agreement, appraisal, and other documents pertaining to the investigation. LPA interviewed two (2) staff and five (5) residents who were at the facility from 9:10 AM to 11:02 AM. LPA reviewed documents at 11:03 AM.

Allegation: Staff threatened the resident.

Continue to LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20260501121812

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: WINNETKA HOME CARE	FACILITY NUMBER: 197610320
	VISIT DATE: 05/07/2026

NARRATIVE

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It was alleged that staff threatened resident #1 (R1) by stating that, ‘if he [R1] does not eat his food, then he would not eat at all’. Interviews with residents revealed that they are happy and have not experienced such treatment from facility staff. Interviews with staff revealed that they treat all their residents with respect and dignity. LPA did not observe any staff speaking inappropriately to R1 or any other residents in care.

Based on interviews and observations, there is insufficient information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Allegation: Staff did not ensure restroom was accessible to the resident.

It was alleged that staff failed to ensure that the restroom was accessible, which led R1 to urinate themselves. During the physical plant tour, LPA observe facility has two (2) bathrooms. Bathroom #1 is located at the end of the hallway and is accessible to all the residents. Bathroom #2 is located inside bedroom #3, where female residents reside, resident #3 (R3) and resident #4 (R4). Interview with R1 at 10:48 AM revealed that the allegation was completely false and stated that they were able to use bathroom #1 located in the hallway. Interview with residents revealed that they use the common bathroom anytime when it's not locked.

Based on interviews and observations, there is insufficient information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Allegation: Staff does not follow resident's dietary needs.

It was alleged that the facility did not accommodate to R1’s salt and sugar diet. Interview with the administrator (S1) and staff (S2) revealed that they accommodate to all of the residents' special diets and food restrictions. Interview with staff revealed that R1 refuses to eat the food served in the facility and would purchase ready-to-eat food from Mom’s Meals. LPA observed that lunch was served at 12:00 PM and R1 stated they refuses to eat what was served: brown rice with beef, stir-fry cabbage, and beans. R1 then requested Mom’s meal to be heated from S2, a cup of vanilla almond milk, and chocolate pudding. Interviews with four (4) residents revealed that their dietary needs are met by the facility. Residents revealed that food alternatives are offered if they dislike that food.

Based on interviews and observations, there is insufficient information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted, and a copy of this report signed and delivered.

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

LIC9099 (FAS) - (06/04)

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