197610320-7-8-2026-31-AS-MGFS-DWXUFZ-20260814153335

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610320
Report Date: 07/08/2026
Date Signed: 07/08/2026 10:49:14 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
06/02/2026 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20260602091101

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:	0	CENSUS: 4	DATE:	07/08/2026
		UNANNOUNCED	TIME BEGAN:	08:22 AM
MET WITH:	Isaiah Phiri- staff designee		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff does not provide resident with clean linens.
Staff does not dispose resident's trash in a timely manner.
Staff does not provide resident's with nutritious meals.
Staff did not deliver resident's mail in a timely manner.
Staff does not ensure that the facility is free of pests.
Staff does not ensure that pathways are free of hazards.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent complaint visit to the facility to investigate the above allegation. LPA met with the facility staff designee, Isaiah Phiri, and explained the reason for the visit.

To investigate the allegation on 06.11.2026, LPA Cava took a tour of the physical plant, interviewed facility staff and five (5) residents who are at the facility. On 6.29.2026, LPA requested the facility staff roster (LIC 500), resident roster (LIC 9020), resident #1 (R1) physician report, appraisal needs and service plan, admission agreement, and other documents pertaining to the investigation.

Allegation: Staff does not provide resident with clean linens.

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: 07/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026

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 4

Control Number 31-AS-20260602091101

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: 07/08/2026

NARRATIVE

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Based on interviews and observations, the licensee has ensured that staff take out trash. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Allegation: Staff does not provide resident's with nutritious meals.

Regarding the allegation that staff does not ensure food is nutritious and well-balanced for residents, it was alleged that the food provided is not well-balanced and is of poor quality, LPA's record review between 9:45 AM to 10:45 AM revealed that the facility menu provides well balanced meal which includes fruit, vegetable and yogurt. Interview with residents between revealed that the food is good, nutritious and of good quality.

Based on interviews and observations, facility staff has ensured that residents has a nutritious meal. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Allegation: Staff did not deliver resident's mail in a timely manner.

It was alleged that staff mishandled R1's mail at the facility. Interview with staff denied the allegation, interview revealed that staff ensures to hand out all residents personal mail for the independent residents and to the responsible persons to dependent residents. LPA interviewed residents revealed that staff ensures that all residents get their personal mail.

Based on the information obtained, there was insufficient evidence to confirm the allegation. Therefore, the findings is Unsubstantiated at this time.

Allegation: Staff does not ensure that the facility is free of pests.

It is alleged that there are pests such bugs in the facility. Interviews with the staff revealed there have not been complaints or concerns in regard to pests at the facility reported by residents. Staff did not observe pests within the facility especially in R1 bedroom.

Continue to LIC 9099-C

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 31-AS-20260602091101

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: 07/08/2026

NARRATIVE

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It was alleged that staff were not ensuring the residents had clean linens. LPA tour at the facility and observed resident bedrooms linen storage and laundry areas. During LPA Cava visit on 6.11.2026 and LPA Ngo-Castaneda on 6.29.2026 and 7.8.2026, it was observed that linens are available in the facility and observed R1’s and all of the residents’ beds made with generally clean sheets. No strong odors, excessive soiling, or lack of available linens were noted during the visit. On 6.29.2026 and 7.8.2026, LPA Ngo-Castaneda did not observe conditions indicating residents were routinely left without clean linens. Interview with facility staff regarding the facilities laundry and linen policy. Staff stated the facility follows a regular laundry schedule and linens are changed every week and additionally as needed when soiled. Staff reported that if a resident's bedding becomes soil due to incontinence or other circumstances staff replaced the linens promptly. Residents interviewed revealed that they received clean linens and that staff assist with changing bedding when needed. Residents reported that bedding changes regularly and more often when necessary. No residents interviewed complained of being left in soiled sheets or denied access to clean linens.

Based on LPA's observations, interviews, and review of facility practices regarding laundry and linen changes there was insufficient evidence to prove that staff are not ensuring the residents have a clean linen. Therefore, the allegation is Unsubstantiated.

Allegation: Staff does not dispose resident's trash in a timely manner.

It was alleged that staff did not dispose R1 trash in a timely manner. On 6.29.2026 and 7.8.2026, LPA inspected R1’s room was tidy with no trash in the trash bin. During physical plant tour, LPA inspected R1’s at 8:46 AM. Interviews with residents revealed staff take out their trash every day. No residents had issues with housekeeping or trash disposal. Interview facility staff revealed they take out trash from resident rooms every morning. LPA also observed staff disposing of common area trash bins and resident room trash bins at approximately at 6.29.2026 and 7.8.2026.

Continue to LIC 9099-C

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 31-AS-20260602091101

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: 07/08/2026

NARRATIVE

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Interview with residents revealed they have not seen, encountered, or had any issues with pest/bed bugs in the facility. LPA Ngo-Castaneda interview with R1 on 6.29.2026 revealed that no pests is observe in their bedroom and no bug bites were observed on any of their body parts during the visit. LPA conducted an inspection of the physical plant and observed residents bedroom to be free of pest.

Based on the interview and observations, there was insufficient evidence to confirm the allegation. Therefore, the findings is Unsubstantiated at this time.

Allegation: Staff does not ensure that pathways are free of hazards.

It was alleged that staff did not ensure that pathways are free of hazards towards the dining area. On 6.11.2026 LPA Cava observed that the pathway to the dining area is free of hazards and obstruction. On 6.29.2026 and 7.8.2026, LPA Ngo-Castaneda observe the dining area pathway to be free of obstruction. Interview with residents revealed that they have no issue or witness the dining area pathway to be obstructed and is free of hazard. Interview with staff revealed that delivery supplies for garage renovation was delivered and it was place at the dining area for a few hours and was move to garage to be installed.

Based on the interview and observations, there was insufficient evidence to confirm the allegation. Therefore, the findings 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: 07/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026

LIC9099 (FAS) - (06/04)

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