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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600370
Report Date: 11/06/2025
Date Signed: 11/06/2025 07:46:08 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #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 Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20251103222431
FACILITY NAME:ADLA INC. #2FACILITY NUMBER:
198600370
ADMINISTRATOR:AIDINOVA, SALBIFACILITY TYPE:
735
ADDRESS:6731 LENNOX AVENUETELEPHONE:
(818) 997-6216
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY:4CENSUS: 4DATE:
11/06/2025
UNANNOUNCEDTIME BEGAN:
02:24 PM
MET WITH:Salbi AidinovaTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Staff left resident unattended.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sandra Urena conducted an initial unannounced visit to investigate the allegation listed above. The LPA arrived at the facility at approximately 2:14 p.m. and rang the bell several time. The LPA then called the Admiistrator's cell number and informed them of the visit explained the reason for the visit. The Administrator was unable to come to facility due to being far away from the facility.

LPA Urena interviewed the Administrator at approximately 2:21p.m. and requested records pertinent to the investigation. The Administrator stated that they will email the LPA a copy of the updated schedule to ensure staff is present wnen clients arrive early to the faccility.

Continues on LIC 9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
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 29-AS-20251103222431
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ADLA INC. #2
FACILITY NUMBER: 198600370
VISIT DATE: 11/06/2025
NARRATIVE
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Staff left resident unattended.
On the allegation that staff left a resident unattended, it is the concern of the reporting party (RP) that a resident arrived at the facility earlier than expected due to early dismissal from work. On arrival at the facility the resident had to wait for approximately an hour outside the facility because no staff were available at the facility to supervise the resident. Furthermore, it was reported that the resident sits outside the facility daily for 30-60 minutes waiting for the staff to return to the facility.

To investigate the allegation LPA Urena communicated with the RP on 11/05/2026, and the RP indicated that they had spoken with the resident (R1) who confirmed the information provided in the alleagtion. Furthermore, the RP reported that (R1) arrived to the home at 3:07 PM and no staff were available at the facility, so the RP called the Administrator and requested that a staff go to the facility. RP reported that R1 disclosed that they sit outside the home daily for 30-60 minutes waiting for the staff (S1) to return to the facility. The RP also spoke with S1, who confirmed the information provided by R1. The interview with the Administrator revealed that R1 did not communicate with anyone (staff) at the facility to inform them that their work schedule had changed on that day, or any other day; consequently the staff was not aware that R1 would arrive earlier than usual to the facility. Furthermore, the Administrator stated that take full responsibility of the incident and they have already made changes to the staff's schedule to ensure that staff will be available when the R1 arrives at the facility.

Based on the information obtained through interviews and credible sources, the allegation that staff left R1 unsupervised and unattended outside the facility when they return from work to the facility, is deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations (CCR), the following deficiencies were cited (refer to LIC 9099-D).



Administrator was unable to be present at the facilitiy and the LPA read the report on the phone. The Administrator allowed a designated staff to sign off on the report.

Citations were issued. Interview exit was conducted. A copy of the report and Appeal Rights was issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20251103222431
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: ADLA INC. #2
FACILITY NUMBER: 198600370
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/06/2025
Section Cited
CCR
80078(a)
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80078 (a) Responsibility for Providing Care and Supervision(a)The licensee shall provide care and supervision as necessary to meet the client's needs.
This requirement was not met:

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The deficiency has been cleared as of today 11/06/2025. The Administrator has submitted an updated staffing schedule indicating that the home will have staff present daily to meet the needs of residents at all times.

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Based on interviews conducted it was confirmed that R1 was not provided supervision which caused R1 to be unsupervised outside the facility for approximately 30 to 60 minutes while waiting for staff to arrive. This poses an immediate 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: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
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