197610320-5-26-2026-31-AS-MGFS-DWWMDT-20260813093141

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610320
Report Date: 05/26/2026
Date Signed: 05/26/2026 01:12:43 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
05/21/2026 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20260521105122

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:	05/26/2026
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Isaiah Phirii- staff designee		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility television is in disrepair.
Staff do not ensure resident’s shower floor is not a slipping hazard.

INVESTIGATION FINDINGS:

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At approximately 8:20 AM, Licensing Program Analysts (LPA), Leslie Ngo-Castaneda arrived at the facility in response to the above-mentioned allegation. LPA met with the staff designee and explained the reason for the visit. At 8:31 AM, LPA spoke with the administrator by phone regarding the reason for the visit.

At approximately 8: 50 AM, LPA conducted a physical plant tour to ensure the health and safety of the residents are protected. At 8:40 AM, LPA requested copies of pertinent information, which include, but are not limited to, Physician’s report, Admission Agreement, LIC 500 (staff roster), LIC 9020 (resident roster), needs and service plan, and relevant documents to the investigation. LPA interviewed the Administrator over the phone, staff designee who are in the facility, and five (5) out of five (5) residents.

Allegation: Facility television is in disrepair.

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: 05/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026

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-20260521105122

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: 05/26/2026

NARRATIVE

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Regarding the allegation, it is reported that staff did not ensure that the Wi-Fi internet was fixed in a timely manner for the television to function. An interview with the Administrator over the phone revealed that the Wi-Fi has been intermittently working in the facility for approximately a week. The administrator stated that Spectrum, the internet provider, has been contacted and visited twice, on 5/21/2026 and 5/23/2026, to resolve the matter, the internet is still intermittent. During the LPA visit, it was observed that staff designee uses their hot spots for Wi-Fi access. Interview with residents revealed that although the Wi-Fi is down, they have no concerns since if/when they ask for assistance to access the internet, it is always granted.

Therefore, based on interviews and observations, this allegation is deemed unsubstantiated.

Allegation: Staff do not ensure resident’s shower floor is not a slipping hazard.

It was alleged that staff did not ensure the resident's shower floor was not a slipping hazard. An interview with the staff designee revealed that resident #1 (R1) wanted to use a bath towel on the floor instead of the shower mat. Interview with R1 revealed that they do not like using the shower mat and were adamant about using a bath towel on the floor. It was also revealed to LPA that R1 denied slipping/ fall in the bathroom. LPA did not observe any bruise/ injuries on R1 body. During the physical plant tour, LPA observed a shower mat, grab bars, and a shower chair available for the residents to use. An interview with residents revealed that the shower mat is always placed in front of them during the shower.

Therefore, based on interviews and observations, this allegation is deemed unsubstantiated.

No citation issued. Exit interview conducted. A copy of the report was provided to the staff designee.

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026

LIC9099 (FAS) - (06/04)

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