198601809-7-28-2026-29-AS-KHEN-DWHT4M-20260731142410

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601809
Report Date: 07/28/2026
Date Signed: 07/28/2026 01:40:02 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
05/21/2026 and conducted by Evaluator Quoc Huynh

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20260521153559

FACILITY NAME:	ELWYN NC - BABCOCK		FACILITY NUMBER:	198601809
ADMINISTRATOR:	LAURIE HERNANDEZ		FACILITY TYPE:	734
ADDRESS:	5149 BABCOCK AVE		TELEPHONE:	(818) 287-5416
CITY:	VALLEY VILLAGE	STATE: CA	ZIP CODE:	91607
CAPACITY:	5	CENSUS: 5	DATE:	07/28/2026
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Betty Davis - House Manager		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not ensure resident saw primary care physician within the required time frame
Staff did not follow residents admission agreement

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Quoc Huynh conducted a subsequent complaint visit for the above allegations. The LPA arrived at 1:15PM and met with House Manager Betty Davis. Administrator Terrance Henson was contacted via telephone call. Entrance interview conducted.

On 05/22/2026, the LPA conducted an initial visit. Between 1:38PM and 3:10PM, the LPA conducted a physical plant tour, interviewed three (3) staff and the Administrator, and reviewed and obtained pertinent documents.

During today’s visit, the LPA and House Manager conducted a physical plant tour at 1:17PM and no immediate concerns were observed. The following was then determined:

Report Continued on LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026

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 29-AS-20260521153559

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: ELWYN NC - BABCOCK	FACILITY NUMBER: 198601809
	VISIT DATE: 07/28/2026

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 did not ensure resident saw primary care physician within the required time frame” and “Staff did not follow residents admission agreement”

It was reported that Resident #1 (R1) did not see their primary care physician within sixty (60) days as required by the facility’s plan of operation. Interview and record review confirmed that R1’s previous primary care visit occurred on 03/09/2026, with the next follow-up appointment scheduled for 05/15/2026. This appointment date exceeded the sixty (60) day requirement, resulting in a sixty-seven (67) day gap.

The House Manager stated that on 05/07/2026, they identified that the upcoming primary care appointment would not meet the required timeframe. The House Manager reported contacting R1’s primary care provider to request an earlier appointment; however, the provider had no availability. Additionally, the provider informed the House Manager that the scheduled 05/15/2026 appointment would need to be moved to 05/22/2026 due to physician unavailability. As a result, the facility took R1 to an urgent care clinic in an attempt to temporarily fulfill the requirement.

Review of the facility’s plan of operations states: “Provision for the consumer to be examined by [their] primary care physician at least once every 60 days, or more frequently, if indicated.” This established a clear requirement for staff to ensure residents are seen by their primary care physician every sixty (60) days.

Review of resident admission agreements revealed that while the agreements do not explicitly state a sixty (60) day primary care requirement, they do specify that the facility must operate in compliance with Title 17 and Title 22 regulations, as well as its approved plan of operation.

Based on interviews and record review, the preponderance of evidence standard has been met; therefore, the allegation “Staff did not ensure resident saw primary care physician within the required time frame” is deemed SUBSTANTIATED at this time. The allegation “Staff did not follow residents admission agreement” is deemed SUBSTANTIATED and considered a TECHNICAL VIOLATION with no deficiency cited.

Pursuant to Title 22 CA Code of Regulations and/or the Health and Safety Code, the following deficiency was cited (Refer to 9099-D).

Exit interview conducted. A copy of the appeal rights and report was reviewed and provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20260521153559

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: ELWYN NC - BABCOCK	FACILITY NUMBER: 198601809
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/28/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/28/2026 Section Cited CCR 80022(k)	1 2 3 4 5 6 7	(k) The facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The Licensee created a plan to schedule residents' PCP appointments within 40 days, rather than 60 days to account for any unforeseen issues. POC cleared.
	8 9 10 11 12 13 14	Based on interview and record review, the Licensee did not comply with the above cited section in R1 did not see their primary care physician within the time frame specified in the Plan of Operation which posed a potential health, safety, and 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.

SUPERVISOR'S NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3