197610320-3-5-2026-31-AS-NGID-DT6LMM-20260415085300

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610320
Report Date: 03/05/2026
Date Signed: 03/05/2026 02:37:07 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
02/25/2026 and conducted by Evaluator Perchui Khurshudyan

COMPLAINT CONTROL NUMBER: 31-AS-20260225152904

FACILITY NAME:	WINNETKA HOME CARE		FACILITY NUMBER:	197610320
ADMINISTRATOR:	KAPIKYAN, ANDRANIK		FACILITY TYPE:	740
ADDRESS:	19733 HEMMINGWAY ST		TELEPHONE:	(818) 434-9916
CITY:	WINNETKA	STATE: CA	ZIP CODE:	91306
CAPACITY:	6	CENSUS: 4	DATE:	03/05/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Nick Kapikyan - Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff does not ensure bathroom toilet is kept in good repair.

INVESTIGATION FINDINGS:

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On 3/5/2026 at approximately 9:30am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an unannounced initial visit to investigate the above allegation. Upon arrival LPA met with the Staff/Caregiver Isaiah Phiri and explained the reason for the visit. The facility Administrator Nick Kapikyan got contacted over the phone and arrived shortly after.

At approximately 9:45am LPA conducted a physical plant tour to ensure health and safety of the residents are protected. At approximately 9:55am, LPA requested residents and staff rosters. Between 10:00am – 11:00am, LPA conducted interviews with the Administrator, one (1) staff/Caregivers, and four (4) out of four (4) residents residing in the facility.

Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

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-20260225152904

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: 03/05/2026

NARRATIVE

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Allegation: Staff does not ensure bathroom toilet is kept in good repair.

It was reported that staff turned the water off to one of the toilets that is located in the master bedroom and that the toilet is not operational. To investigate this allegation, LPA conducted tour of the bathroom referenced in the complaint, and other resident accessible bathrooms and observed the master bathroom toilet was operational at the time of the inspection and the second bathroom area under complete renovation. No standing waste or unsanitary condition was observed in the bathroom. During interview, the Administrator stated that as they previously reported to the Department, the facility is going under renovation and that on 2/25/2026 as part of the bathroom work, the water was shut off for approximately fifteen (15) minutes in order to complete plumbing related work. The Administrator also added that residents were informed prior to the shutoff and water service was restored immediately after the work was finished. The facility had at least one other bathroom/toilet available to residents use during the temporary interruption. Interview with the staff/Caregiver stated that the water was temporarily tuned off due to renovation work and was restored shortly after. Staff also added that all residents were informed about the water would be off briefly in master bathroom and were told that the main bathroom is available during the shutoff. Residents interviewed stated that they never experienced problems with the toilet being out of repair and added they never had lack of access to a functional toilet and did not see waste sitting in the toilet. Based on observations and interviews, there is no sufficient evidence to support the allegation. Therefore, the allegation is determined to be Unsubstantiated.

No Deficiency issued during today's visit.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026

LIC9099 (FAS) - (06/04)

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