197610790-8-13-2025-31-AS-AJWR-DPC3WT-20251213173713

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610790
Report Date: 08/13/2025
Date Signed: 08/13/2025 10:46:55 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/17/2025 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20250717084612

FACILITY NAME:	ABUNDANT SENIOR CARE		FACILITY NUMBER:	197610790
ADMINISTRATOR:	VANBEEKOM, SCOTT		FACILITY TYPE:	740
ADDRESS:	20601 MAYALL STREET		TELEPHONE:	(818) 626-9081
CITY:	CHATSWORTH	STATE:	ZIP CODE:	91311
CAPACITY:	6	CENSUS: 5	DATE:	08/13/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ricardo Dizon, Staff		TIME COMPLETED:	11:25 AM

ALLEGATION(S):

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Unlicensed Care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Angela Panushkina and Huma Rahimi conducted a subsequent complaint visit to this house to follow up on an Unlicensed Care Complaint. LPAs were greeted by Staff #1, who granted access to this home. LPAs contacted the Operator and explained the reason for the visit.The Operator was unable to come and designated S1 to sign the report.

On 07/23/25, an initial complaint visit was conducted and interviews with the Operator and staff revealed that five (5) out of five (5) individuals residing in the home required and were receiving elements of care and supervision. Notice of Violation of Law (NOVL) was also issued, and Operator was advised to cease the operation.

The purpose of today’s visit is to confirm that R1, R2, R3, R4 and R5 are no longer residing at this home.
At 10:00am, during the physical plant tour, LPAs observed that five (5) out of five (5) of the aforementioned individuals that required care are still living in the home. Continue on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025

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-20250717084612

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ABUNDANT SENIOR CARE	FACILITY NUMBER: 197610790
	VISIT DATE: 08/13/2025

NARRATIVE

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At 10:15am, LPAs interviewed the Operator and were informed that they did submit an application on 03/21/25. However, the initial Fire Clearance request was for the capacity of six (6) Ambulatory only, which was denied on 07/18/2025. Although the second request for the Fire Clearance (STD850) had been submitted on 08/05/2025 for the capacity of five (5) Non-Ambulatory and one (1) Bedridden residents, the STD850 has not yet been approved nor received by the Community Care Licensing Division (CCLD). It was determined that the Operator has not ceased the operation and failed to relocate five (5) individuals residing in the home who required and are still receiving elements of care and supervision. Elements of care and supervision include assistance with Activities of Daily Living (ADLs), such as bathing, dressing, using the toilet, and arranging medical and dental services.

Based on interviews and observation, it was determined that the Operator continues to provide unlicensed care for five (5) individuals residing in the house. Therefore, a $100 civil penalty per resident per day will be assessed retroactively from 07/23/25 and $200.00 (two hundred) per resident per day will be assessed beginning on the 16th day (08/07/25) until the operation is ceased.

Deficiency/citation is issued on LIC9099-D.
Exit interview conducted. Appeal rights explained and the copy of this report signed and issued.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025

LIC9099 (FAS) - (06/04)

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