197610320-8-21-2026-31-AS-NGID-DXBPZX-20260826114615

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610320
Report Date: 08/21/2026
Date Signed: 08/21/2026 01:56:11 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
05/22/2025 and conducted by Evaluator Perchui Khurshudyan

COMPLAINT CONTROL NUMBER: 31-AS-20250522113258

FACILITY NAME:	WINNETKA HOME CARE		FACILITY NUMBER:	197610320
ADMINISTRATOR:	HARUTUNYAN, ALLA		FACILITY TYPE:	740
ADDRESS:	19733 HEMMINGWAY ST		TELEPHONE:	(818) 434-9916
CITY:	WINNETKA	STATE: CA	ZIP CODE:	91306
CAPACITY:	0	CENSUS: 5	DATE:	08/21/2026
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	James Pangalila - Staff		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff refused to accept resident back at facility following hospitalization.

INVESTIGATION FINDINGS:

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On 8/21/26, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted subsequent complaint visit to deliver the final report. Upon arrival, LPA met with facility Staff James Pangalila and explained the reason for the visit.

During today's visit, LPA conducted physical plant tour to ensure health and safety of the residents are protected and the facility is in compliance with Title 22 Regulations. No health and safety hazards noted during the visit.
During the initial complaint visit conducted by LPA Khurshudyan on 05/29/2025, LPA requested copies of pertinent information, which include but are not limited to copies of Resident’s file / documents, and other information relevant to the investigation. LPA also interviewed four (4) out of four (4) residents residing in the facility who were able to communicate and answer questions, two (2) Caregivers, the Administrator, and the Referral Agent.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2026

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-20250522113258

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: 08/21/2026

NARRATIVE

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Allegation: Staff refused to accept resident back at facility following hospitalization.

To investigate this allegation, LPA Khurshudyan conducted interviews with the Administrator and Referral Agent and reviewed available documents. Records and interviews revealed that Resident 1 (R1) was admitted to the facility on 5/19/2025 after discharge from Kaiser Hospital. The following day, 5/20/25, R1 experienced a behavioral episode involving agitation, screaming, and refusal to enter the facility, creating safety concerns for R1 and other residents. Due to R1’s behavioral condition, facility staff contacted 911, and R1 was transported to Northridge Hospital Medical Center for evaluation. Interviews with the administrator and referral agent indicated that the facility did not intend to abandon R1 or terminate R1's placement. Rather, they believed R1 required further medical and behavioral evaluation by medical professionals and possible medication adjustment before safely returning to the facility. The administrator further stated that the behavioral episode raised concerns regarding whether resident 1’s existing medications were sufficient to manage R1's condition safely. The administrator also confirmed that Northridge hospital staff advised the facility that the hospital could provide prescriptions but could not dispense the requested medications because R1 was a Kaiser health care member and the prescriptions would need to be filed through Kaiser pharmacy. The administrator and referral agent denied accepting R1 back without proper medications available in hand. Furthermore, R1 was transferred to Kaiser hospital for further treatment and medication management. After R1 transferred to Kaiser hospital, one of R1's children decided not to return R1 to the facility and instead took R1 home. Interviews with residents residing in the facility confirmed they are happy with the care and supervision they receive at the facility.

Based on interviews and records reviewed, there was insufficient evidence to establish that the facility intended to abandon R1. The facility requests for further evaluation and medication adjustment were related to R1’s behavior condition and safety concerns. Therefore, the allegation is Unsubstantiated at this time.

No Deficiency cited during today's visit.

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

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2026

LIC9099 (FAS) - (06/04)

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