197610111-2-26-2026-31-AS-MGFS-DS4VUA-20260312164425

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610111
Report Date: 02/26/2026
Date Signed: 02/26/2026 01:49:21 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
09/01/2025 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20250901225658

FACILITY NAME:	CALIFORNIA STATE HEALTH GROUP LLC		FACILITY NUMBER:	197610111
ADMINISTRATOR:	ANDRANIK KAPIKYAN		FACILITY TYPE:	740
ADDRESS:	9526 SALOMA AVE		TELEPHONE:	(818) 810-9339
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	6	CENSUS: 5	DATE:	02/26/2026
		UNANNOUNCED	TIME BEGAN:	12:22 PM
MET WITH:	Muchengei Mangwende- staff designee		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Resident developed multiple unstageable pressure injuries due to neglect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPAs) Leslie Ngo-Castaneda and Michael Cava conducted an unannounced subsequent complaint visit to this facility to investigate the above allegation. LPAs met with staff, Muchengei Mangwende (S3), and explained the reason for visit.

The Regional Office received the complaint on 09.01. 2025. The complaint was referred to the Investigations Branch and accepted the same day. LPA conducted a health and safety visit on September 3, 2025, at 4:00 PM, LPA requested copies of pertinent information which include, but not limited to Physician’s report, Admission Agreement, staff roster (LIC 500), resident roster (LIC 9020), needs and service plan, and relevant documents to the investigation. Between 3:10 PM – 3:30 PM, LPA interviewed the administrator (S1) and one (1) staff (S2) who are in the facility and six (6) out of six (6) residents. On 09.05.2025 and 10/8/25, Investigator Laura Garcia (IB) conducted interviews with staff and residents from around 2:30p.m. to 4:00p.m.
Continue to LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026

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-20250901225658

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: CALIFORNIA STATE HEALTH GROUP LLC	FACILITY NUMBER: 197610111
	VISIT DATE: 02/26/2026

NARRATIVE

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It was alleged that Resident #1 (R1) had multiple unstageable pressure injuries due to neglect while residing at the facility. Interviews with staff indicated that R1 had no pressure injuries while residing at the facility. Interview with residents revealed that they are happy with the staff and provides proper care. All of the residents stated that they currently have no issues with neglect and that staff provide proper care and supervision. Based on document reviewed, it was revealed that R1 was admitted to the facility on 7.15.2025. R1 resided at facility until end of July 29, 2025.

Interview conducted by IB investigator revealed R1’s responsible party removed R1 from the facility and moved R1 to an unknown location on 7/29/25. R1 was hospitalized on 8/19/25, when unstageable pressure injuries were discovered. R1’s physician’s report notes no history of skin condition and was not receiving home health services. There were no records indicating that R1 was receiving care for pressure injuries during R1’s stay at the facility.

Therefore, based on interviews and record review and due to lack of supporting evidence, the allegation is unsubstantiated at this time.

No health and safety hazards were noted during the visit.

Exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026

LIC9099 (FAS) - (06/04)

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