197610638-1-14-2026-31-AS-NGID-DRESV4-20260218131204

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610638
Report Date: 01/14/2026
Date Signed: 01/14/2026 03:18:03 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/06/2026 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20260106085846

FACILITY NAME:	CHATSWORTH COMMONS SENIOR LIVING, LLC		FACILITY NUMBER:	197610638
ADMINISTRATOR:	MONROY, DAVID		FACILITY TYPE:	740
ADDRESS:	20801 DEVONSHIRE ST.		TELEPHONE:	(818) 341-2552
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	268	CENSUS: 141	DATE:	01/14/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Anchirriza Concepcion, Health and Wellness Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff are not meeting resident's incontinence care needs

INVESTIGATION FINDINGS:

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At 09:30am, Licensing Program Analyst (LPA), Angela Panushkina conducted an unannounced visit in response to the above-mentioned allegation. LPA met with the Administrator and explained the reason for the visit.

At 09:35am, LPA requested residents and staff roster. At 09:40am, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, Incontinence Plan of Care, Staff Training relevant to the investigation. At approximately 10:00am, LPA conducted a physical plant tour. Between 10:05am – 01:00pm, LPA conducted an interview with the Administrator, one (1) MedTech, one (1) Licensed Vocational Nurse (LVN), two (2) staff, and twelve (12) out of fourteen (14) residents.

Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

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-20260106085846

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CHATSWORTH COMMONS SENIOR LIVING, LLC	FACILITY NUMBER: 197610638
	VISIT DATE: 01/14/2026

NARRATIVE

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Allegation: Staff are not meeting resident's incontinence care needs

It was alleged that facility staff failed to provide the correct size incontinence supplies for R1 by using size - XL diapers rather than size - XXL diapers for about a week. To investigate this allegation the LPA conducted interview with the Administrator and was informed that the facility maintains adequate incontinence supplies for residents in care and provides incontinent products as part of routine care. The Administrator stated that staff change residents in a timely manner according to their needs and facility routines every two (2) hours or as needed. The Administrator further stated that incontinence supplies are provided to all residents, unless a resident prefers/chooses a specific brand, in which case the resident or responsible party may purchase it themselves. Administrator also informed LPA that R1 is currently receiving services from California Advancing and Innovating Medi-Cal (CalAIM) Program, and as soon as R1 is running low on incontinent supplies, the facility places an order right away for the same day delivery. During today’s visit, LPA was provided with the receipt verifying an incontinence supply order for R1 was placed on January 6^th, 2026, at 8:30am, and the order was delivered on January 6^th, 2026, at 11:50am. Document supported that the facility provided incontinence supplies on time. All staff interviewed corroborated with the statement provided by the Administrator. Lastly, twelve (12) out of fourteen (14) residents interviewed expressed no concerns regarding the above allegation. Therefore, based on interviews and document reviews this allegation is deemed, Unsubstantiated, at this time.

No deficiency issued during today's visit.

Exit interview conducted, appeal rights explained and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

LIC9099 (FAS) - (06/04)

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