191221159-5-13-2025-31-AS-NGID-DHBMG3-20250604093514

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191221159
Report Date: 05/13/2025
Date Signed: 05/13/2025 01:05:43 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.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
03/13/2025 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20250313154140

FACILITY NAME:	MAHARLIKA HOMES		FACILITY NUMBER:	191221159
ADMINISTRATOR:	GARDOSE, NOELLIE L.		FACILITY TYPE:	740
ADDRESS:	17843 CANTARA STREET		TELEPHONE:	(818) 343-3936
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	4	CENSUS: 4	DATE:	05/13/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Monique Gardose, Administrator Designeee		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Licensee does not ensure bedbug issue is being handled in an appropriate manner.

INVESTIGATION FINDINGS:

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At 9:30 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced subsequent complaint visit to investigate the above allegation. LPA met with Monique Gardose, the Administrator Designee, who granted access to the facility and LPA explained the reason for the visit.

An initial visit was conducted on 03/21/2025. During today's visit, interviews and record review were made. At 9:40 AM, LPA requested residents and staff roster. At 9:50 AM, LPA conducted a physical plant tour. At 10:00 AM, LPA requested copies of pertinent information which include, but not limited to FENN Termit and Pest Control Invoices, receipts of newly purchased items, and etc relevant to the investigation. Between 10:10 AM – 11:30 AM, LPA conducted an interviews with the Administrator Designee, Staff #1 (S1) and three (3) out of four (4) residents avaliable to interview.
Continue on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

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-20250313154140

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: MAHARLIKA HOMES	FACILITY NUMBER: 191221159
	VISIT DATE: 05/13/2025

NARRATIVE

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Licensee does not ensure bedbug issue is being handled in an appropriate manner.

It’s alleged the facility has had bedbug issues for some time and are not seeking professional service for eradication/extermination. To investigate this allegation LPA conducted an interview with the Administrator Designee and S1 who confirmed that the facility did have bedbug issues only in R1’s room; however, it was treated and eradicated professionally and as well followed the proper protocol on a personal level by removing all infested items from R1’s room and placing them in a plastic bag to treat them. During the initial complaint visit on 03/21/2025, LPA observed all items being in a plastic bag and were placed outside of the facility which confirms the statement provided by the Administrator Designee and S1. The Administrator Designee also informed LPA that the infested mattress and bed were replaced with newly purchased bed and mattress for R1. Moreover, as a precaution the entire facility including all clients’ rooms were treated and sprayed four times with FENN Termite and Pest Control company in the month of March 2025. Document reviewed from FENN Termite and Pest Control company confirmed that the facility was inspected and treated for bedbugs during the month of March 2025. During facility's tour LPA observed four (4) residents rooms Including R1's room and all rooms were observed clean. Each bed, bedding, and mattresses were clean, and no bedbugs were observed. Lastly, during interviews with three (3) out of four (4) residents, all residents stated to have no concerns with bedbugs being in their rooms or in the facility. Therefore, based on interviews, record review, and LPA’s observation during initial complaint and today’s visit this allegation is deemed unsubstantiated at this time.

An exit interview was conducted and a copy of the report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

LIC9099 (FAS) - (06/04)

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