<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610638
Report Date: 06/04/2026
Date Signed: 06/04/2026 05:47:50 PM

Substantiated


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
11/03/2025 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20251103124311
FACILITY NAME:CHATSWORTH COMMONS SENIOR LIVING, LLCFACILITY NUMBER:
197610638
ADMINISTRATOR:MONROY, DAVIDFACILITY TYPE:
740
ADDRESS:20801 DEVONSHIRE ST.TELEPHONE:
(818) 341-2552
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:268CENSUS: 164DATE:
06/04/2026
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:David Monroy, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not providing adequate food service to resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At 1:05pm, Licensing Program Analyst (LPA) Angela Panushkina conducted subsequent complaint visit to deliver the final report. Upon arrival, LPA met with the Administrator, David Monroy, and explained the reason for the visit.

LPA requested residents and staff rosters. LPA also conducted a physical plant tour to ensure health and safety of the residents are protected.

On 11/04/25, LPA initiated the complaint visit. LPA requested resident and staff roster. At 9:40am, requested copies of pertinent information which include, but not limited to Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, Staff Training, relevant to the investigation. At approximately 9:45am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected.
Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
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 7
Control Number 31-AS-20251103124311
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: 06/04/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Between 10:00am - 3:30pm, LPA conducted an interview with the Administrator, Welness Director, two (2) housekeepers, three (3) staff, two (2) MedTechs and ten (10) out of thirteen (13) residents.

Allegation: Staff are not providing adequate food service to resident

It was alleged that residents are not provided with balanced meals. To investigate this allegation, LPA conducted an interview with the Administrator who indicated that weekly menus are prepared in advance and meals are monitored by kitchen staff. The Administrator reported recent complaints from residents regarding food quantity or quality and stated that Regional Food & Beverage Director (RFBD) was already invited for today’s (11/04/25) Resident Council Meeting to discuss the outcome. Three (3) staff members interviewed reported that they serve meals according to the posted menu; however, staff confirmed that occasional substitutions occur due to supply shortages. Ten (10) out of thirteen (13) residents interviewed reported that meals are sometimes “small,” “plain,” or “not filling.” Multiple residents confirmed the meals “do not come with fruit, vegetables, or a side,” and that this type of minimal meal had occurred on multiple occasions. During the initial visit, LPA directly observed the lunch meal being served to residents. The meal consisted solely of two slices of bread and approximately five slices of turkey lunch meat. No fruits, vegetables, or side items were provided. No beverage was observed being served with the meal at the time of observation. The meal did not appear to be balanced, complete, or nutritious and did not meet Title 22 requirements for residents to receive well-balanced meals containing appropriate portions of protein, grains, vegetables, and fruits. Menu review for the week on 11/04/25 indicated that lunch for the date of visit was scheduled to include a smoked cheddar carnitas quesadilla – pork carnitas stuffed in a tortilla with hickory smoked cheese, with pinto beans, Mexican zucchini and dessert. The meal served did not match the posted menu. Therefore, based on interviews and LPA observation this allegation is Substantiated.

Deficiency issued on LIC9099-D

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: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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
11/03/2025 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20251103124311

FACILITY NAME:CHATSWORTH COMMONS SENIOR LIVING, LLCFACILITY NUMBER:
197610638
ADMINISTRATOR:MONROY, DAVIDFACILITY TYPE:
740
ADDRESS:20801 DEVONSHIRE ST.TELEPHONE:
(818) 341-2552
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:268CENSUS: DATE:
06/04/2026
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:David Monroy, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained a fracture due to staff neglect
Staff are not meeting resident's incontinence needs
Staff are not providing resident with toilet paper
Staff are not calling resident's authorized representative about resident's care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At 1:05pm, Licensing Program Analyst (LPA) Angela Panushkina conducted subsequent complaint visit to deliver the final report. Upon arrival, LPA met with the Administrator, David Monroy, and explained the reason for the visit.

On 11/04/25, LPA initiated the complaint visit. LPA requested resident and staff roster. At 9:40am, requested copies of pertinent information which include, but not limited to Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, Staff Training, relevant to the investigation. At approximately 9:45am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 10:00am - 3:30pm, LPA conducted an interview with the Administrator, Maintenance Director, Welness Director, two (2) housekeepers, three (3) staff, two (2) MedTechs and ten (10) out of thirteen (13) residents.

Continue on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 31-AS-20251103124311
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: 06/04/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
On 11/05/25, the complaint was referred to Investigations Branch (IB) for further investigation. Additional interviews were conducted with the Administrator (on 12/01/25), R1 (on 12/01/25) and credible witnesses (12/09/25). The Department also subpoenaed R1's medical records on 12/09/25 and reviewed the records on 12/22/25.

Allegation: Resident sustained a fracture due to staff neglect

To investigate the allegation, the Department conducted an interview with the Administrator. The Department also conducted an interview with R1, who did not disclose sustaining any broken bones at any time during their residency at the facility. Additionally, during the investigation, medical reports for Kaiser Hospital documenting R1’s visits from the period of 01/01/2023 to 07/25/25. Per the medical reports, there was no indication of R1 sustaining a “broken arm” or any other fractures. However, there was a reported “wrist injury” in October 2023. R1 reported getting their right wrist/forearm caught in a door handle. R1 acknowledged staff members witnessed the incident. Per the medical report, R1 did not sustain any fractures to their wrist as a result of that incident. Lastly, during the course of the investigation, R1 did not disclose, nor did R1 allege sustaining a broken arm during their residency at the facility. There was also no documentation of R1 sustaining a broken or fractured arm in any of R1’s past medical reports. Therefore, based on interviews and record reviews obtained during the investigation, this allegation is deemed Unsubstantiated, at this time.

Allegation: Staff are not meeting resident's incontinence needs

It was alleged that R1 is using tissue instead of incontinence pads. To investigate this allegation, LPA conducted an interview with the Administrator and was informed that the staff follow each resident’s care plan, including assistance with incontinence care. Administrator reported no known concerns from residents or families regarding staff failing to meet incontinent needs.

Continue on LIC9099-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 31-AS-20251103124311
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: 06/04/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Administrator stated that staff receive ongoing training related to incontinent care and documentation. LPA also conducted an interview with R1, who denied the above allegation and confirmed that the statement provided by the Administrator is true and accurate. LPA was informed that R1 prefers to use their own personal "tactic" with toilet tissue instead of the incontinence pads provided by the facility. During the initial visit, LPA observed that R1’s room contained multiple boxes of diapers and incontinence pads readily available for use. LPA observed no indication that the R1’s needs were unmet at the time of the visit. Interview with four (4) staff revealed that they are aware of R1’s preference and continue to offer incontinent care in accordance with R1’s care plan. All staff interviewed also informed LPA that incontinence checks are conducted routinely, typically every 2 hours or as needed per resident’s care plan. Lastly, ten (10) residents interviewed expressed no concern regarding this allegation. Therefore, based on interviews and LPA observation this allegation is deemed Unsubstantiated, at this time.

Allegation: Staff are not providing resident with toilet paper



To investigate this allegation, LPA conducted an interview with the Administrator, who denied the allegation and stated that the facility maintains an adequate supply of toilet paper and incontinent products at all times. The Administrator reported that supplies are restocked daily and as needed. Two (2) housekeepers interviewed stated that toilet paper is routinely provided to all residents and replenished upon request. Staff denied any instances of withholding hygiene supplies. Three (3) staff stated that they had not received any complaints from residents regarding lack of toilet paper. Ten (10) out of thirteen (13) residents interviewed reported that they have access to toilet paper, when needed. Residents stated that staff respond to requests for supplies in a timely manner. No residents reported issues with receiving toilet paper. Lastly, during the visit, LPA observed the facility’s storage area. Toilet paper and incontinent supplies were available, organized, and fully stocked. No shortages were observed. Therefore, based on interviews and LPA observation this allegation is deemed Unsubstantiated, at this time.

Continue on LIC9099-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 31-AS-20251103124311
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: 06/04/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff are not calling resident's authorized representative about resident's care

To investigate this allegation, LPA conducted an interview with the Administrator and was informed that facility protocol requires staff to contact residents’ authorized representatives, power of attorney (POA), or family members any time there is a change in condition, care needs, or if an incident occurs. LPA was also informed that staff are trained on this procedure and that documentation of such notifications is maintained in each resident file. Three (3) staff and two (2) MedTechs’ interviewed denied the allegation. Staff members consistently stated that they notify a resident’s representative immediately when there are updates regarding the resident’s care, changes in condition, or other significant events. Staff further stated that they are aware of the facility’s communication policy and follow it. Lastly, ten (10) residents interviewed expressed no concern regarding this allegation and informed the facility keeps their families or authorized representatives informed about their care and any changes. A review of resident files showed multiple entries where the facility had notified the authorized representatives regarding appointments, changes in condition, and other relevant matters. Therefore, based on interviews and record review this allegation is deemed Unsubstantiated, at this time.

No deficiency issued.

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: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 31-AS-20251103124311
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/11/2026
Section Cited
CCR
87555(a)
1
2
3
4
5
6
7
General Food Service Requirements. The total daily diet provided for the residents shall be selected, stored, prepared and served in a safe and healthful manner and shall be of the quality and in the quantity necessary to meet the needs of the residents.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The Aministrator informed LPA that he was aware of food concerns and invited Regional Food & Beverage Director (RFBD) for Resident Council Meeting to discuss the outcome (on 11/04/25). Deficiency cleared during the visit.
8
9
10
11
12
13
14
Based on interviews and LPA observation, the licensee did not comply with the section cited above as eight (8) out of ten (10) residents interviewed informed LPA that the facility provides poor quality food/small portions/ not balanced/nutritious to the residents. which poses/posed a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
LIC9099 (FAS) - (06/04)
Page: 7 of 7