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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610320
Report Date: 02/12/2026
Date Signed: 02/12/2026 03:03:46 PM

Substantiated


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
02/04/2026 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20260204112256
FACILITY NAME:WINNETKA HOME CAREFACILITY NUMBER:
197610320
ADMINISTRATOR:HARUTUNYAN, ALLAFACILITY TYPE:
740
ADDRESS:19733 HEMMINGWAY STTELEPHONE:
(818) 434-9916
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:6CENSUS: 4DATE:
02/12/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nick Kapikyan- AdministratorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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9
Staff did not prevent smoke from entering the facility.
Staff did not keep facility free of insects.
Staff does not maintain a comfortable temperature for residents in care.
INVESTIGATION FINDINGS:
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At 9:00 Am, Licensing Program Analysts (LPAs) Mariana Agban and Perchui Milena Khurshudyan and Licensing Program Manager (LPM) Nichelle Gillyard conducted an initial 10-day complaint visit to investigate the above allegations. At approximately 09:05am, LPAs and LPM conducted a physical plant tour. LPAs requested copies of pertinent information which includes and not limited to Residents files, Staff Roster, Resident Roster. At 9:40 Am, LPAs and LPM met with Administrator Nick Kapikyan and explained the reason for the visit. Between 9:00- 10:15, LPAs and LPM interviwed 2 resdidents, attempted interview two other residents and the Administrator.

Allegation: Staff did not prevent smoke from entering the facility.
It was alleged that staff leave the facility door open while residents smoke outside, allowing smoke to enter the facility. During the physical plant tour, LPA observed two residents smoking in the backyard while the sliding glass door remained open, which allowed smoke to enter the interior of the facility. Interview with Resident #1 (R1) revealed that staff are often occupied and do not consistently close the door when the two residents are smoking.(Continued on LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
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 6
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
02/04/2026 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20260204112256

FACILITY NAME:WINNETKA HOME CAREFACILITY NUMBER:
197610320
ADMINISTRATOR:HARUTUNYAN, ALLAFACILITY TYPE:
740
ADDRESS:19733 HEMMINGWAY STTELEPHONE:
(818) 434-9916
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:6CENSUS: 4DATE:
02/12/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nick Kapikyan- AdministratorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure that facility sink is delivering hot water.
Staff are not serving an adequate amount of food portions to a resident in care
Staff did not prevent a resident from using foul language towards another resident in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
At 9:00 Am, Licensing Program Analysts (LPAs) Mariana Agban and Perchui Milena Khurshudyan and Licensing Program Manager (LPM) Nichelle Gillyard conducted an initial 10-day complaint visit to investigate the above allegations. At approximately 09:05am, LPAs and LPM conducted a physical plant tour, to ensure health and safety of the residents are protected. LPAs requested copies of pertinent information which includes and not limited to Residents files, Staff Roster, Resident Roster. At 9:40 Am, LPAs and LPM met with Administrator Nick Kapikyan and explained the reason for the visit. Between 9:00- 10:15, LPAs and LPM interviewed 2 residents, attempted interview two other resident and the Administrator.

Allegation: Staff did not ensure that facility sink is delivering hot water.
It was alleged that the sink in the men’s bathroom did not provide hot water. During the physical plant tour, LPA Agban measured the hot water temperature at the main bathroom sink and recorded temperatures of 114.3°F and 117.3°F. The private bathroom sink measured 110.5°F.Interview with Resident #2 (R2) confirmed that the facility provides hot water and stated that there have been no issues regarding water temperature. (Continue on 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 31-AS-20260204112256
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: WINNETKA HOME CARE
FACILITY NUMBER: 197610320
VISIT DATE: 02/12/2026
NARRATIVE
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Based on LPA’s observations and interviews conducted, the allegation is deemed Unsubstantiated at this time.

Allegation: Staff are not serving an adequate amount of food portions to a resident in care
it was alleged that facility staff served only a banana as breakfast to a resident. During the physical plant tour, LPAs and LPM observed that one resident was served eggs, pork chorizo, yogurt, and bread for breakfast. Additionally, LPAs observed that the facility maintained a sufficient supply of both perishable and non-perishable food items properly stored, including eggs, yogurt, frozen meats, fruits, and vegetables. Interviews confirmed 1 out of 4 residents state that food portions provided at the facility are adequate. Two of the 4 residents did not want to be interviewed. Based on LPA’s observations and interviews conducted, the allegation is deemed Unsubstantiated.

Allegation: Staff did not prevent a resident from using foul language towards another resident in care.
It was alleged that a resident used inappropriate language within the facility. Interview with 1 out of 4 residents denied the allegation and stated that they had not witnessed any resident using inappropriate language. LPA and LPM attempted to interview 2 out of 4 residents; however, both residents declined to be interviewed. Based on the information obtained, there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted, copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 31-AS-20260204112256
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: WINNETKA HOME CARE
FACILITY NUMBER: 197610320
VISIT DATE: 02/12/2026
NARRATIVE
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Based on LPA’s observations and the interview conducted with R1, the allegation is deemed Substantiated at this time.

Allegation: Staff did not keep facility free of insects.
It was alleged that flies were entering residents’ rooms. During the physical plant tour, LPM/LPA observed screen window and screen doors to be in good repair. LPA and LPM observed a large mosquito and a large black gnat insect on the wall in Room #4. LPM observed the sliding door in room #4 to be open cracked letting insect in. Staff was busy with other tasks and did not observed or close the door to keep the room free from insects. LPA/LPM interviewed R1 who confirmed the allegation. R1 stated that backyard doors are frequently left open, allowing insects to enter the facility. Even though the administrator contracts monthly with a pest control company it is staff's responsibility to make sure screen doors and the sliding doors are maintained closed to keep the facility free from insects. Based on LPA’s observations and interviews conducted, the allegation is deemed Substantiated at this time.


Allegation: Staff does not maintain a comfortable temperature for residents in care
It was alleged that staff maintain the facility at a cold temperature. During the physical plant tour, LPAs and LPM observed that the NEST thermostat was turned off. The temperature in the common areas measured 65°F, and resident rooms measured approximately 67°F. Interview with R1 confirmed the allegation, stating that residents were required to wear additional layers due to the low temperature. The Administrator stated that it is challenging to adjust the temperature to accommodate everyone’s preference simultaneously. Based on LPA’s observations and interviews conducted, the allegation is deemed Substantiated at this time.

Exit interview conducted, citations issued, appeal right given and copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 31-AS-20260204112256
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: WINNETKA HOME CARE
FACILITY NUMBER: 197610320
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/17/2026
Section Cited
CCR
87468.1(a)(2)
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Personal Rights(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations.. This requirement is not met as evidenced by;
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Administrator agreed to provide plan to avoid smoke enter the interior of the facility by the POC date.
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Based on observations and interview, LPAs and LPM observed two residents smoking in the backyard while the sliding glass door remained open, which allowed smoke to enter the interior of the facility. Staff did not close the door. This poses potential risk to the personal rights of the residents in care.
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Type B
02/17/2026
Section Cited
CCR
87303(a)
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Maintenance and Operations The facility shall be clean, safe, sanitary... at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors..
This requirement is not met as evidenced by;
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Administrator agreed to provide proof of pest control services by the POC date.
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Based on observations and interview, LPM and LPA observed a mosquito and a large black insect on the wall in Room #4. Staff did not make sure the door was closed.This poses potential risk to the personal rights of the residents 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: Nichelle Gillyard
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 31-AS-20260204112256
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: WINNETKA HOME CARE
FACILITY NUMBER: 197610320
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/17/2026
Section Cited
CCR
87303(b)
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2
3
4
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6
7
Maintenance and Operation(b) A comfortable temperature for residents shall be maintained at all times.This requirement is not met as evidenced by;
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Administrator agreed to provide a plan to keep comfortable temperature for residents by the POC date.
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Based on observations and interview, LPAs and LPM that the thermostat was turned off. The temperature in the common areas measured 65°F, and resident rooms measured approximately 67°F. This poses potential risk to the personal rights of the residents 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: Nichelle Gillyard
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6