197610721-7-7-2026-31-AS-MGFS-DW3UN8-20260717154332

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610721
Report Date: 07/07/2026
Date Signed: 07/07/2026 04:17:44 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.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
02/19/2026 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20260219085327

FACILITY NAME:	HAVEN OASIS SENIOR LIVING, INC		FACILITY NUMBER:	197610721
ADMINISTRATOR:	PRAMONO, HANANIAH		FACILITY TYPE:	740
ADDRESS:	8032 GLADE AVE		TELEPHONE:	(310) 903-2453
CITY:	CANOGA PARK	STATE: CA	ZIP CODE:	91304
CAPACITY:	6	CENSUS: 5	DATE:	07/07/2026
		UNANNOUNCED	TIME BEGAN:	03:17 PM
MET WITH:	Aldin Martinez- Staff Designee		TIME COMPLETED:	04:25 PM

ALLEGATION(S):

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Resident developed multiple pressure injuries in care due to staff neglect

INVESTIGATION FINDINGS:

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This report is a correct version of report dated 5/23/2026 to add an additional deficiency and additional information on the LIC9099.

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent visit to this facility to deliver findings. LPA met with staff (S1), Aldin Martinez, who granted access to the facility.

On 2/19/2026, the Woodland Hills South Adult and Senior Care Regional Office received a complaint regarding above allegation. Initial investigation was conducted by LPA on 2/20/2026. LPA requested the following documents: staff roster (LIC 500);
resident roster (LIC 9020), residents’ physician’s report, admissions agreement,
appraisal needs and service plan, hospice care plan, and other documents.

Continue to LIC 9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026

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 4

Control Number 31-AS-20260219085327

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: HAVEN OASIS SENIOR LIVING, INC	FACILITY NUMBER: 197610721
	VISIT DATE: 07/07/2026

NARRATIVE

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LPA interviewed five (5) out of five (5) residents, staff designee and three (3) staff from 1:14 PM until 2:12 PM. LPA reviewed resident’s records from 2:14 PM until 3:45 PM. LPA took a tour of the physical plant with the assistance of the administrator at 1:13PM. On 3/9/2026, LPA requested R1’s hospital medical records.

Regarding allegation: Resident developed multiple pressure injuries in care due to staff neglect.

It is alleged that on 2/17/2026 R1 had an appointment with their Geriatrician and R1 has several stage 3 wounds. R1 was admitted to the facility on 5/23/2025, record review, appraisal needs and service plan and preplacement appraisal (LIC 603), revealed that R1 did have an unstageable wound on their coccyx. All of the residents interviewed during the investigation did not address any concerns regarding their care at the facility. Hospital medical records reviewed reveal R1 had developed pressure injuries on their coccyx, sacral, and bilateral heel. Wound started developing on 4/14/2025 before R1 was admitted to the facility. An interview with staff revealed repositioning assistance was provided to avoid and give relief to pressure injuries by staff. Interview with R1’s responsible party revealed that they are happy with the care given by the facility and were not aware that R1 required higher level of care or were clear regarding the care hospice will provide.

Records reviewed reveal that all of the staff are trained by the administrator and were following home health instructions on how to care for R1’s wounds. A review of hospital medical records revealed R1 was admitted to home health on 5/29/2025. On 5/29/2025 sacral wound stage 3 was noted to measure 1.5 cm x 1 cm x 0.2 cm. On 8.7.2025 medical records noted coccyx wound was noted as stage 2. On 5/21/2026, LPA called and spoke to R1 family revealed that they refused to admit R1 to hospice. On 11/3/2025, additional wounds were noted to the right heel (full thickness skin loss) stage 3 measuring 2.25 cm x 2.5 cm x 0.2 cm. Family eventually agreed for R1 was to be admitted to hospice on 11/3/2025. On 2/5/2026, it was noted that R1 had stage 3 wounds on their right (R) heel measuring 2.25 cm x 2.5 cm x 0.2 cm. On 2/18/2026 right heel was noted as unstageable.
Continue to LIC 9099-C.

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 31-AS-20260219085327

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: HAVEN OASIS SENIOR LIVING, INC	FACILITY NUMBER: 197610721
	VISIT DATE: 07/07/2026

NARRATIVE

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Although R1 was receiving home health care and hospice care, staff were providing required assistance, pressure injuries were not healing and developed into unstageable wounds. Facility staff admitted R1 on 5/23/2025 with stage 3 wound and upon development of new stage 3 wounds from 5/29/26 to 2/20/2026 R1 was retained at the facility. Therefore, the allegation is substantiated.

Based on observation, interviews, and record review, there is sufficient evidence. Therefore, the allegation is deemed substantiated California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099-D.

An immediate Civil Penalty of $500.00 will be issued during this visit due to neglect/lack of care by providing care to R1 with a prohibited health condition. An additional civil penalty may be assessed at a later time based on Health and Safety Code 1569.49.
Deficiency noted on 4/23/26 remains the same.

An exit interview was conducted. Appeal rights, a copy of the report, LIC 9099D, were provided.

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 31-AS-20260219085327

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: HAVEN OASIS SENIOR LIVING, INC	FACILITY NUMBER: 197610721
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/07/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/08/2026 Section Cited CCR 87468.2(a)(4)	1 2 3 4 5 6 7	To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.	1 2 3 4 5 6 7	Administrator will create a plan that will identify pre-placement assessment process, retention or seeking medical care upon evaluation of wounds, will certify in writing that understands regulation sections 87609, 87615, and 87616 and will submit a copy of both to the department by POC due date.
	8 9 10 11 12 13 14	Based on observation, interviews, and medical records reviewed licensee did not ensure to obtain proper medical care for R1 upon observation of stage 3 wounds which poses an immediate health, safety, or personal rights risk to the 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: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026

LIC9099 (FAS) - (06/04)

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