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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610364
Report Date: 10/07/2025
Date Signed: 10/07/2025 10:57:52 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
03/10/2025 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250310120257
FACILITY NAME:ANITA'S COTTAGEFACILITY NUMBER:
197610364
ADMINISTRATOR:GURULE, MARIOFACILITY TYPE:
740
ADDRESS:27736 SYCAMORE CREEK ROADTELEPHONE:
(818) 667-8166
CITY:VALENCIASTATE: CAZIP CODE:
91354
CAPACITY:5CENSUS: 3DATE:
10/07/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Nazrul Sekh TIME COMPLETED:
11:15 AM
ALLEGATION(S):
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1. Staff are not following resident's Admissions Agreement
2. Staff did not give proper notice of resident's room change
3. Staff did not communicate with resident's responsible party
INVESTIGATION FINDINGS:
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On 10/06/2025, Licensing Program Analyst (LPA) Tuesday Cabiness arrived at the facility at 9:45 a.m. to conduct a subsequent visit, deliver the final findings regarding the above-mentioned complaint, and conduct a physical plant inspection. LPA met with caregiver Nazrul Sekh and explained the purpose of the visit. Administrator Mario Gurule was not available for the visit, but was notified. The following was determined:

Allegation #1: Staff are not following residents’ Admission Agreement. To investigate this allegation, on 03/18/2025, from 11:00 a.m. to 12:30 p.m., (LPA) interviewed the complainant and obtained documents related to the complaint. On 03/20/2025, LPA conducted the initial complaint visit from 9:30 a.m. to 2:15 p.m., during which (2) staff and (2) residents, including Resident #1 (R1), were interviewed, and R1’s records were reviewed. A subsequent visit was conducted on 08/07/2025, from 11:20 a.m. to 12:30 p.m., to conduct additional interviews. According to R1’s Admission Agreement, R1 rented a private room with no roommate. Recently, the Administrator temporarily relocated R1 to a shared room to allow for repairs and renovations to the private room. (Cont'd LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
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 6
Control Number 31-AS-20250310120257
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: ANITA'S COTTAGE
FACILITY NUMBER: 197610364
VISIT DATE: 10/07/2025
NARRATIVE
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After the repairs were completed, R1 informed the LPA that the shared room was more comfortable and spacious and expressed a desire to remain there. R1 acknowledged being fully aware that the room is designated for shared occupancy and agreed to the possibility of having a roommate. R1 stated being happy, content, and wishing to stay in the shared space. Although it was reported that the facility was not following the Admission Agreement, evidence shows that R1 voluntarily chose to remain in the shared room, exercising their personal rights. Therefore, based on interviews and record reviews, there is insufficient evidence to prove or disprove the allegation. The allegation is deemed Unsubstantiated.

Allegation #2: Staff did not give proper notice of residents’ room change. To investigate this allegation, on 03/18/2025, from 11:00 a.m. to 12:30 p.m., (LPA) interviewed the complainant and obtained documents related to the complaint. On 03/20/2025, LPA conducted the initial complaint visit from 9:30 a.m. to 2:15 p.m., during which (2) staff and (2) residents, including Resident #1 (R1), were interviewed, and R1’s records were reviewed. A subsequent visit was conducted on 08/07/2025, from 11:20 a.m. to 12:30 p.m., to conduct additional interviews. Information obtained during the investigation revealed that R1 was temporarily relocated to a shared room while renovations and repairs were completed in R1’s private room. Although it was noted that R1 has the power of attorney (POA) for financial and health decisions, R1 personally chose to remain in the shared room after the repairs were completed, exercising R1’s personal rights. Because this relocation was based on R1’s voluntary decision, and not an involuntary move imposed by facility staff, there was no requirement to issue formal notice of the room change. R1 confirmed to LPA that remaining in the shared room was R1’s personal choice and decision. Therefore, based on interviews, there is insufficient evidence to support the allegation. The allegation is deemed Unsubstantiated.

Allegation #3: Staff did not communicate with resident's responsible party. To investigate this allegation, on 03/18/2025, from 11:00 a.m. to 12:30 p.m., (LPA) interviewed the complainant and obtained documents related to the complaint. On 03/20/2025, LPA conducted the initial complaint visit from 9:30 a.m. to 2:15 p.m., during which (2) staff and (2) residents, including Resident #1 (R1), were interviewed, and R1’s records were reviewed. LPA also reviewed email documentation provided by R1’s family, the complainant, and the Administrator. A subsequent visit was conducted on 08/07/2025, from 11:20 a.m. to 12:30 p.m., to conduct additional interviews. According to documentation reviewed, multiple email communications occurred between the Administrator and R1’s family. (Cont'd LIC9099C - page 2)
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 31-AS-20250310120257
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: ANITA'S COTTAGE
FACILITY NUMBER: 197610364
VISIT DATE: 10/07/2025
NARRATIVE
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The Administrator also informed R1 that the shared room could potentially be rented to another resident, and R1 acknowledged and accepted this possibility. Although it was noted that R1 has a (POA) for financial and health decisions, R1 independently chose to remain in the shared room, exercising R1’s personal rights. As such, there was no requirement for staff to obtain POA consent regarding this personal decision. Based on interviews and documentation, there is insufficient evidence to support the allegation. The allegation is deemed Unsubstantiated.

Exit interview conducted, and copy of report provided to Administrator.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
03/10/2025 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250310120257

FACILITY NAME:ANITA'S COTTAGEFACILITY NUMBER:
197610364
ADMINISTRATOR:GURULE, MARIOFACILITY TYPE:
740
ADDRESS:27736 SYCAMORE CREEK ROADTELEPHONE:
(818) 667-8166
CITY:VALENCIASTATE: CAZIP CODE:
91354
CAPACITY:5CENSUS: 3DATE:
10/07/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Mario GuruleTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff are increasing resident's rate
INVESTIGATION FINDINGS:
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On 10/06/2025, Licensing Program Analyst (LPA) Tuesday Cabiness arrived at the facility at 9:45 a.m. to conduct a subsequent visit, deliver the final findings regarding the above-mentioned complaint, and conduct a physical plant inspection. LPA met with caregiver Nazrul Sekh and explained the purpose of the visit. Administrator Mario Gurule was not available for the visit, but was notified. The following was determined:

On 03/18/2025, from 11:00 a.m. to 12:30 p.m., (LPA) interviewed witnesses involved with the complaint and obtained relevant documents. On 03/20/2025, LPA conducted the initial complaint visit from 9:30 a.m. to 2:15 p.m., during which LPA requested resident #1’s (R1) admission agreement, notification of rental increase, appraisal/needs and services plan, and related email correspondence. During the visit, LPA interviewed staff and residents, including R1, and reviewed facility records. LPA also reviewed email documentation provided by R1’s family and the Administrator. A subsequent visit was conducted on 08/07/2025, from 11:20 a.m. to 12:30 p.m., to conduct additional interviews. The investigation revealed that R1 originally signed an admission
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 31-AS-20250310120257
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: ANITA'S COTTAGE
FACILITY NUMBER: 197610364
VISIT DATE: 10/07/2025
NARRATIVE
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agreement for a private room but was temporarily relocated to a shared room due to facility renovations. It was alleged that R1 was charged an additional $1,100 for the shared room. The investigation determined that the Administrator did not provide proper notice of the rent increase and that there was no valid justification for the additional charge.

A review of R1’s admission agreement showed that the additional services listed in the rent increase notice were already included as basic services. LPA also reviewed the facility’s admission policy, which states that rent increase notices must be issued annually and must not include costs for additional services. Review of R1’s records and the rental increase notice confirmed that the notice included not only the rent increase amount but also charges for additional services. There was no updated or current reappraisal to verify significant changes in R1’s level of care that would justify an additional increase in rent. Based on interviews and record review, it was determined that the Licensee/Administrator did not follow the facility’s admission policies, admission agreement, or procedures regarding annual rent increases. Therefore, the allegation is SUBSTANTIATED.

Exit interview conducted and copy of report provided to staff.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 31-AS-20250310120257
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: ANITA'S COTTAGE
FACILITY NUMBER: 197610364
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/28/2025
Section Cited
HSC
1569.655(a)
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§1569.655 Increase in fee rates for elderly residents; 60 days’ written notice stating amount of and reasons for increase; application of section.(a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services
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Licensee shall review and revise facility procedures to ensure all future rate increases comply with Title 22 requirements, including providing residents with at least 60 days written notice and excluding any services already listed as part of the basic rate. Licensee shall submit proof of revised
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... notice to the residents or the residents’ representatives setting forth the amount of the increase and...reasons for the increase, including a description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident. This requirement was not met, evidenced by, based on documentation reviewed and interviews, the Administrator did not give a proper notice rental increase to (R1's) POA nor did he not follow the facility’s admission policies, admission agreement, or procedures regarding annual rent increases.
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admission agreement templates and rent increase notification procedures to CCLD by 10/28/2025.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6