197610505-9-17-2025-31-AS-NGID-DN6THF-20251106134440

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610505
Report Date: 09/17/2025
Date Signed: 09/17/2025 12:30:10 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
09/08/2025 and conducted by Evaluator Perchui Khurshudyan

COMPLAINT CONTROL NUMBER: 31-AS-20250908104023

FACILITY NAME:	FAIRHAVEN HOME 1		FACILITY NUMBER:	197610505
ADMINISTRATOR:	KULUNGU, LAILA		FACILITY TYPE:	735
ADDRESS:	20601 KITTRIDGE STREET		TELEPHONE:	(818) 274-1809
CITY:	WINNETKA	STATE: CA	ZIP CODE:	91306
CAPACITY:	6	CENSUS: 6	DATE:	09/17/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Laila Kulungu - Administrator		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff did not ensure vehicle used to transport residents is in safe operating condition.

INVESTIGATION FINDINGS:

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On 9/17/2025 at 9:45am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an unannounced, initial 10-day complaint visit to investigate the above allegation. Upon arrival, LPA met with Caregiver/House Manager Helen Comfort Oviri, introduced herself by showing her badge, and explained the reason for the visit. Entrance interview conducted. Facility administrator Laila Kulungu arrived shortly after.

To investigate the complaint, LPA requested copies of client and staff rosters, clients’ files and obtained copies of pertinent documents related to the investigation.
LPA conducted a physical plant tour at approximately 10:35am to ensure health and safety of the clients are protected and observed that the house is generally clean, organized, free of odor. Between 10:40am – 11:45am, LPA conducted interviews with the Administrator, the Licensee, one (1) Caregiver, and two (2) out of six (6) clients in care who were present at home during the visit.

Continue on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025

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-20250908104023

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: FAIRHAVEN HOME 1	FACILITY NUMBER: 197610505
	VISIT DATE: 09/17/2025

NARRATIVE

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Allegation: Staff did not ensure vehicle used to transport residents is in safe operating condition.

It was reported that on 8/27/2025, a credible witness from NLACRC conducted an unannounced visit to the facility and observed that one of the administrators exit a vehicle that had visible damages, and a cardboard and blue tape attached to it. To investigate the allegation and to obtain information that that the vehicle used to transport clients is/was in safe operation condition, LPA conducted interviews with two (2) clients, who were present during the visit. Both clients confirmed that they have never gone out in the vehicle referenced in the complaint and reported that they have not seen it being used for outings or any appointments. One (1) staff member interviewed stated that they saw the car one time when the Administrator arrived at the facility, but it was never used to transport clients. Interview with the Administrator denied ever transporting clients in that vehicle and clarified that it was/is for personal use for that day, which has never been utilized for facility related transportation. The Administrator also showed the car parked on the driveway of the facility and provided photographs of the actual vehicles the facility uses for transporting clients to appointments or outings. Observation by the LPA supported the statement, as the vehicle identified for client transport were consistent with the information provided by the Administrator and facility caregiver.

Based on interviews, observations, and information obtained during the investigation, there is insufficient evidence to support the allegation of Staff did not ensure vehicle used to transport clients is in safe operating condition. Therefore, the allegation listed above is deemed Unsubstantiated at this time.

No deficiency cited during today’s visit.

Exit interview conducted, copy of the report delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025

LIC9099 (FAS) - (06/04)

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