197610682-3-25-2026-31-AS-NMAN-DU4L4N-20260515082549

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610682
Report Date: 03/25/2026
Date Signed: 03/25/2026 01:24:30 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.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
11/10/2025 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20251110164024

FACILITY NAME:	MAGNOLIA HOME, THE		FACILITY NUMBER:	197610682
ADMINISTRATOR:	SHERMAN, CELENA		FACILITY TYPE:	740
ADDRESS:	6707 SAUSALITO AVE		TELEPHONE:	(661) 236-6787
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	5	CENSUS: 3	DATE:	03/25/2026
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Celena Sherman		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility neglect resulted in a resident sustaining a pressure injury

INVESTIGATION FINDINGS:

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At approximately 9:00 a.m. on 03/25/26 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the administrator and disclosed the reason for the visit.

Regarding the allegation "Facility neglect resulted in a resident sustaining a pressure injury" it was alleged Resident #1 (R1) was hospitalized with a large wound in their groin area. To investigate the allegations above, LPA conducted an initial visit on 11/13/25 and interviewed staff, a home health nurse, and residents between 9:10 a.m. and 12:30 p.m., conducted a record review of pertinent records at 10:00 a.m., including but not limited to a medication list, care notes, and staff and resident lists, and toured the facility inside and out at 10:15 a.m. LPA conducted a subsequent visit today and toured the facility at 9:10 a.m. and reviewed home health records and photographs at 9:30 a.m.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026

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-20251110164024

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: MAGNOLIA HOME, THE	FACILITY NUMBER: 197610682
	VISIT DATE: 03/25/2026

NARRATIVE

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*** This amendment was created to correct an error on the original report - LPA NR 05/14/26***

Interview with the administrator at 10:30 a.m. on 11/13/25 revealed R1 had no deep tissue pressure injuries upon admission. Telephone call with R1’s home health nurse at approximately 11:00 a.m. on 11/13/25 revealed R1 had some redness around their left ankle but no pressure injuries. The home health nurse sent photos of R1’s ankle from 10/31/25 showing redness but no open skin. Record review of R1’s home health care plan indicated they started services on 10/10/25 for assistance with Parkinson’s disease, heart disease, and a Stage 2 pressure ulcer on their left ankle. Nurse notes from 10/31/25 and 11/04/25 also indicated R1 had a Stage 2 pressure injury on their left ankle. No other pressure injuries or skin tears were noted. Interview with Staff #1 (S1) at 9:30 a.m. revealed R1 was hospitalized on 11/08/25 after expressing some pain from an unwitnessed fall. Record review of R1’s hospital records indicated they had a stage 2 pressure injury on the ankle. There was no indication of a wound around the groin area. Interviews with Staff #2 (S2) at 9:00 a.m. on 11/13/25, S1, and the administrator revealed they had not observed any wounds, redness or pressure injuries around R1’s groin area prior to or after R1’s hospitalization. Based on interviews and record review, there is not enough evidence to indicate facility neglect led to R1 sustaining a pressure injury. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health or safety concerns were observed during today’s visit.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026

LIC9099 (FAS) - (06/04)

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