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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197601489
Report Date: 07/24/2025
Date Signed: 07/24/2025 02:07:06 PM

Unsubstantiated


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
06/10/2025 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20250610172856
FACILITY NAME:CARRIE'S BOARD AND CAREFACILITY NUMBER:
197601489
ADMINISTRATOR:CARRIE ACOSTAFACILITY TYPE:
740
ADDRESS:8430 COLBATH AVENUETELEPHONE:
(818) 893-7619
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:6CENSUS: 2DATE:
07/24/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Carrie AcostaTIME COMPLETED:
11:13 AM
ALLEGATION(S):
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Staff are not providing residents adequate food service.
Staff do not provide linens for residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent visit to deliver findings for the allegations listed above. The LPA met with the Administrator Carrie Acosta and explained the reason for the visit.

On 06/10/2025, the Department received a complaint from a reporting party, and on 06/16/2025, Licensing Program Analyst (LPA) Sandra Urena conducted an initial unannounced visit to investigate the allegations listed above. The LPA met with the Administrator Carrie Acosta and explained the reason for the visit. LPA Urena interviewed the Administrator and staff and requested records pertinent to the investigation. On 07/23/2025, the LPA interviewed two current residents, reviewed additional records, and inspected the physical plant.
Continues on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
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 5
Control Number 29-AS-20250610172856
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: CARRIE'S BOARD AND CARE
FACILITY NUMBER: 197601489
VISIT DATE: 07/24/2025
NARRATIVE
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Staff are not providing residents with adequate food service.
On the allegation that the facility staff are not providing adequate food service, the concern of the reporting party (RP) is that R1 reported that they lost weight because the food was disgusting, and R1 was concerned about their protein intake. To investigate the allegation the LPA interviewed the staff and two current residents, and observed the refrigerator’s supply of perishable food, and the pantry for non-perishable food. The review of perishable and non-perishable food availability was observed to be adequate. Residents’ interviews revealed that they have sufficient food to eat, they get three meals a day, and snacks. The LPA interviewed R1, and the interview revealed that they did not care for the meals prepared by staff. Furthermore, R1 stated that they required a special diet, and staff did not provide R1 with the adequate fluids/beverages, that they lost . R1’s physician report and file review revealed that R1 did not have a special diet. The staff interviews revealed that they try to prepare eggs and toast in the mornings, oatmeal and cereals. For lunch they may prepare rice, fish, sausages, and vegetables.
Although the allegation may have happened or is valid, based on the interviews, observation, and record review, there is not sufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff do not provide linens for residents.
On the allegation that facility staff are not providing residents with linens, it is alleged that R1 was not receiving towels as requested. To investigate the allegation the LPA conducted a physical plant tour to observe the linen supply of towels, sheets and blankets. The supply of linens and towels was observed to be adequate to serve six (6) residents at the time of the visit. LPA Urena interviewed R1, and R1 stated that staff would change the cloth hand towel hanging in the bathroom only once a week. Furthermore, R1 stated that staff would not provide the required paper towels in the bathroom. R1 stated that the staff refused to wash R1’s comforter, because it was not the one provided by the facility. Residents currently residing at the facility did not express concern about the linens. Staff denied changing cloth hands towels once a week or refusing to wash R1’s personal blanket. Staff stated that they change bed linens as often as necessary and/or once a week.
Although the allegation may have happened or is valid, based on the interviews, observation, and record review, there is not sufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed Unsubstantiated at this time.
Interview exit was conducted. A copy of the report was issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
06/10/2025 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20250610172856

FACILITY NAME:CARRIE'S BOARD AND CAREFACILITY NUMBER:
197601489
ADMINISTRATOR:CARRIE ACOSTAFACILITY TYPE:
740
ADDRESS:8430 COLBATH AVENUETELEPHONE:
(818) 893-7619
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:6CENSUS: 2DATE:
07/24/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Carrie AcostaTIME COMPLETED:
11:13 AM
ALLEGATION(S):
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Staff held retained resident at the facility against their will.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent visit to deliver findings for the allegations listed above. The LPA met with the Administrator Carrie Acosta and explained the reason for the visit.

On 06/10/2025, the Department received a complaint from a reporting party, and on 06/16/2025, Licensing Program Analyst (LPA) Sandra Urena conducted an initial unannounced visit to investigate the allegations listed above. The LPA met with the Administrator Carrie Acosta and explained the reason for the visit. LPA Urena interviewed the Administrator and staff and requested records pertinent to the investigation. On 07/23/2025, the LPA interviewed two current residents, reviewed additional records, and inspected the physical plant.

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

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20250610172856
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: CARRIE'S BOARD AND CARE
FACILITY NUMBER: 197601489
VISIT DATE: 07/24/2025
NARRATIVE
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Staff held retained resident at the facility against their will.
On the allegation that staff held the resident at the facility against their will, it is the concern of the RP that the staff would not allow R1 to leave the facility. To investigate the allegation the LPA conducted interviews and reviewed records. The Administrator’s interview revealed that R1 would express that they wanted to go out on walks, but that staff was not able to accompany R1, so the Administrator would tell R1 that they could not leave the facility on their own, without staff going with them. Record review of R1’s physician’s report indicated that R1 was not able to leave the facility unassisted. The interview with R1 revealed that the door was not locked all the time, and they could possibly have been able to walk out the door, but the Administrator would threaten R1 not to allow them back into the facility if they left unassisted. Furthermore, R1 added that they saw a staff hammer a nail at the top of the front door. The nail was then bent to keep the front door from opening and was utilized to prevent another resident who consistently wanted to elope from the facility. The LPA conducted an inspection of the front door, and during the inspection observed that indeed, a bent nail was nailed to the frame of the front door, the nail could then be positioned against the door to prevent it from opening.

Based on information obtained from interviews and observation, although the facility staff did not hold R1 from eloping by physically restraining them, language was used to threaten R1, and staff did not make accommodations for R1 to go on supervised walks. Furthermore, a nail was placed on the front door frame and used to keep the door from opening and preventing residents from going to the front yard of the house. Therefore, the allegation that staff held residents against their will, 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).

Citations were issued. Exit interview 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: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20250610172856
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: CARRIE'S BOARD AND CARE
FACILITY NUMBER: 197601489
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/31/2025
Section Cited
CCR
87468.1(a)(3)(6)
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87468.1(a)(3)(6) Personal Rights of Residents in All Facilities
(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be free from punishment,humiliation, intimidation… other actions of a punitive nature,... (6)To leave or depart the facility at any time and to not be locked into
any room, building, or on facility premises by day or night. This does not prohibit a licensee from …such as locking doors at night to
protect residents…with permission from the Department. This requirement is not met as evidenced by:
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POC: Licensee/Administrator agrees to review regulation for understanding and submit a self-certification of reviewing and understanding the regulations.

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Based on observation, the staff did not meet the requirement due to placing a nail to prevent residents from opening front door, and threatening residents. The Administrator removed the nail from front door frame during the inspection visit.
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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: 07/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5