197610500-5-7-2026-31-AS-TAGD-DVRSRN-20260707140634

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610500
Report Date: 05/07/2026
Date Signed: 05/07/2026 03:08:35 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
04/29/2026 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20260429094049

FACILITY NAME:	A WELLNEST CARE RCFE II		FACILITY NUMBER:	197610500
ADMINISTRATOR:	RATHI, SHIKHA		FACILITY TYPE:	740
ADDRESS:	23347 DALBEY DRIVE		TELEPHONE:	(419) 973-1111
CITY:	SANTA CLARITA	STATE: CA	ZIP CODE:	91355
CAPACITY:	6	CENSUS:	DATE:	05/07/2026
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Shikha Rathi		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff did not provide adequate care and supervision to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to this facility to investigate the above allegation. LPA met with Shikha Rathi and explained the reason for the visit.

--- Staff did not provide adequate care and supervision to resident.

It was alleged that on April 21, 2026, Staff #1 (S1) observed brown liquid and maggots in Resident #1’s (R1) nose and notified the Responsible Party (RP). In addition to notifying the RP, facility contacted R1’s hospice agency who later cleaned and diagnosed R1 with nasal myiasis. It was also alleged that on April 25, 2026, R1 was observed with dried blood on the nose and that staff are not brushing R1’s teeth causing it to turn black in color.

(CONT LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Abeye Duguma
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-20260429094049

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: A WELLNEST CARE RCFE II	FACILITY NUMBER: 197610500
	VISIT DATE: 05/07/2026

NARRATIVE

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To investigate the allegation, LPA conducted a physical plant tour and requested documents at 10:45a.m., interviewed two (2) staff from 11:00a.m. to 12:00p.m. and three (3) out of five (5) residents. LPA was unable to interview R1. During the physical plant tour, LPA observed all residents were clean and well-groomed. A review of the Physician’s Report states resident needs assistance with all activities of daily living. A review of the hospice care plan states R1 is actively dying, has constipation issues, is at risk for skin breakdown, bed bound and reduced food intake. The care plan lists interventions such as ongoing assessment, hazard free environments and monitor effectiveness of current and new medications. A review of staff schedule shows there at least two (2) caregivers during the day shift and one (1) at night. LPA selected three (3) staff files for review. A review of selected facility files shows all staff have completed the required training. During interviews, Staff #1 (S1) and Staff #2 (S2) stated residents are checked on every hour or more if needed. S2 explained that hospice nurse was present thirty (30) minutes prior to noticing the change in condition. S2 added hospice agency and responsible party were contacted and a nurse was dispatched same evening. S1 stated the condition cleared up by the following day. Regarding the April 25th dried blood incident, both S1 and S2 stated they could not identify it as blood and immediately contacted the hospice agency. They came the same day and cleaned it. During interviews, all residents stated they are checked on often and feel facility provides adequate care and supervision.

Based on interviews, observations and record review, there is not enough information to verify the allegation, therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted during the visit.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Abeye Duguma
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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