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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610653
Report Date: 05/12/2026
Date Signed: 05/12/2026 03:30:10 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
05/04/2026 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20260504170801
FACILITY NAME:CHRISTIAN ANGELFACILITY NUMBER:
197610653
ADMINISTRATOR:KAYIIRA, KASIBANTEFACILITY TYPE:
735
ADDRESS:40711 WIMBLEDON COURTTELEPHONE:
(661) 523-5398
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:4CENSUS: 1DATE:
05/12/2026
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Julianna Namujuzi - RelativeTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility is not sufficiently staffed to meet the needs of residents in care
INVESTIGATION FINDINGS:
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At 10:45 am, Licensing Program Analysts (LPAs) Huma Rahimi and Jose Tan conducted an unannounced 10-day complaint visit at this facility to investigate the above allegation. LPAs met with the Licensee relative who was waiting outside of the facility and provided access to the facility. LPAs contacted the Administrator via telephone and explained the reason for the visit.

During the course of the investigation, interviews were conducted. At approximately 1:35 PM, LPAs conducted a physical plant tour. LPAs requested copies of facility documents relevant to the investigation, however, no documents were provided as there is none admitted by the Administrator. Between 1:35 PM – 2:30 PM, LPAs conducted an interview with the Administrator and Deparment of Mental Health Navigator.

Continue on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026
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 3
Control Number 31-AS-20260504170801
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CHRISTIAN ANGEL
FACILITY NUMBER: 197610653
VISIT DATE: 05/12/2026
NARRATIVE
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Allegation: Facility is not sufficiently staffed to meet the needs of residents in care

It was reported by a credible witness that the facility did not have sufficient staff to provide care and supervision to a resident in care. To investigate this allegation, LPAs conducted an interview with the credible witness on 05/11/2026, who stated that during a site visit conducted on 05/01/2026 from approximately 10:15 AM to 11:00 AM, the credible witness arrived at the facility with the Administrator and observed only one (1) resident present at the facility without any staff to provide care and supervision in the absence of the Administrator. The credible witness further stated that the Administrator confirmed there was no staff assigned during daytime or overnight hours and advised that she “drops in regularly” or calls the resident to check in.

Additionally, during today’s visit, per the Administrator the resident currently living is out of the facility at this time and did not know when the resident will be back. At approximately 1:25 PM, LPA conducted an interview with the Administrator, who confirmed that no staff had been hired due to the facility not being fully operational and awaiting to be vendored by the North Los Angeles County Regional Center (NLACRC).

Therefore, based on interviews conducted and observations made, the allegation is deemed substantiated at this time.

Citation issued. Appeal rights explained and issued.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20260504170801
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CHRISTIAN ANGEL
FACILITY NUMBER: 197610653
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/13/2026
Section Cited
CCR
80065(a)
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Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs.

This requirement is not met as evidenced by:
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Administrator agreed to relocate R1 and R1's relocation information will be submitted to LPA by the POC due date. And further agreed not to accept any clients/resident until they are vendored by the North Los Angeles Regional Center.
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Based on interview and LPAs' observation, licensee failed to enure proper staffing to meet R1's needs at all times which poses an immediate health and safety risks to clients in care.
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Type B
05/19/2026
Section Cited
CCR
80022(j)
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Any changes in the plan of operation which affect the services to clients shall be subject to licensing agency approval and shall be reported as specified in Section 80061 - Reporting Requirements.

This requirement is not met as evdenced by:
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Administrator agreed to relocate R1 and R1's relocation information will be submitted to LPA by the POC due date. And further agreed not to accept any clients/resident until they are vendored by the North Los Angeles Regional Center.
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Based on interview and LPAs' observation, licensee failed to enure staffing in accordance with the approved plan of operation to have 24 care and supervision for residents in care which poses/posed a potential health and safety risk to clients in care.
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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: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026
LIC9099 (FAS) - (06/04)
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