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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405800987
Report Date: 09/25/2025
Date Signed: 09/25/2025 01:37:14 PM

Substantiated


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
09/22/2025 and conducted by Evaluator Garrett Haner-Tomasko
COMPLAINT CONTROL NUMBER: 29-AS-20250922190818
FACILITY NAME:IRENE'S BOARD & CAREFACILITY NUMBER:
405800987
ADMINISTRATOR:ANGELITA O. MARAVILLASFACILITY TYPE:
740
ADDRESS:220 VIA PROMESATELEPHONE:
(805) 227-0276
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:6CENSUS: 4DATE:
09/25/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Caregiver - Julita PlarisanTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff does not ensure sharp items are inaccessible to residents.
Staff does not ensure cleaning products are locked away.
INVESTIGATION FINDINGS:
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At 9:15am, on 9/25/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to investigate the allegations of this complaint. LPA met with Caregiver - Julita Plarisan, announced who he was and the reason for the visit. The Licensee/Administrator Angelita Maravillas was not at the facility, LPA attempted to contact her by mobile phone with no answer, the staff contacted her via facebook messanger audio. LPA explained the reason for the visit to the Licensee and they gave permission for Caregiver Julita Plarisan to sign this report.

During the visit the LPA conducted interviews with residents, staff, the licensee, and collected relevant documentation.

On the allegations, staff does not ensure sharp items are inaccessible to residents and staff does not ensure cleaning products are locked away. It was alleged by a reliable source that toward the beginning of this week
(Continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
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
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
09/22/2025 and conducted by Evaluator Garrett Haner-Tomasko
COMPLAINT CONTROL NUMBER: 29-AS-20250922190818

FACILITY NAME:IRENE'S BOARD & CAREFACILITY NUMBER:
405800987
ADMINISTRATOR:ANGELITA O. MARAVILLASFACILITY TYPE:
740
ADDRESS:220 VIA PROMESATELEPHONE:
(805) 227-0276
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:6CENSUS: 4DATE:
09/25/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Caregiver - Julita PlarisanTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Facility did not have an adequate amount of fruit and vegetables.
INVESTIGATION FINDINGS:
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At 9:15am, on 9/25/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to investigate the allegation of this complaint. LPA met with Caregiver - Julita Plarisan, announced who he was and the reason for the visit. The Licensee/Administrator Angelita Maravillas was not at the facility, LPA attempted to contact her by mobile phone with no answer, the staff contacted her via facebook messanger audio. LPA explained the reason for the visit to the Licensee and they gave permission for Caregiver Julita Plarisan to sign this report.

During the visit the LPA conducted interviews with residents, staff, the licensee, and collected relevant documentation.

(Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
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 5
Control Number 29-AS-20250922190818
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: IRENE'S BOARD & CARE
FACILITY NUMBER: 405800987
VISIT DATE: 09/25/2025
NARRATIVE
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 On allegation, facility did not have an adequate amount of fruit and vegetables. It was alleged by a reliable source that there was limited to no fruit and vegetables on hand for the residents in care toward the beginning of this week in September 2025.

During todays visit LPA observed approximately two ripe bananas, five oranges, nine apples, a full bag of purple grapes, four small tomatoes, five heads of lettuce, a half a bag of cut broccoli and an unopened 5 lb bag of mixed frozen vegetables which is an acceptable amount of perishable foods for 4 residents, for two days. LPA noted that there are more than a dozen canned fruits and vegetables in the pantry. LPA interviewed Licensee, who stated, they go shopping at least once a week or twice a week if needed. Residents stated to LPA during interview that they get enough fruits and vegetables. One resident stated they really like vegetables and usually get extra and another stated the staff meet their low carbohydrate diet needs. Based on all interviews conducted and documents obtained, at this time the above allegation was found to be unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted over the phone with Licensee and the Caregiver present at the facility, report signed, and report provided to the Caregiver.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20250922190818
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: IRENE'S BOARD & CARE
FACILITY NUMBER: 405800987
VISIT DATE: 09/25/2025
NARRATIVE
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in September 2025 that the laundry room door and bathroom door across from the laundry room were left open leaving disinfectants, cleaning solutions, and laundry detergent unattended and accessible to residents in care. Additionally, at about the same time the kitchen knife drawer was left unlocked, a knife and pair of scissors were left on the kitchen counter unattended and accessible to residents in care.

During today's visit LPA toured the facility and noted the laundry room door was closed, but unlocked. LPA observed the staff working in and around the laundry room at the time not leaving it unattended. LPA did not observe any cleaning solutions left unlocked in the bathroom across from the laundry room. The knife drawer was locked and no knives or scissors were left out unattended. LPA interviewed Licensee regarding the specific incident in the allegation and the Licensee admitted that at the time of the alleged incident the staff were caring for a resident in the resident's private room leaving all of the items listed in the allegation unattended by staff and accessible to the other 3 residents in care. Based on all interviews conducted and documents obtained, at this time the above allegation was found to be substantiated, there is a preponderance of the evidence to prove that the alleged violation occurred.

The facility was previously cited for disinfectants and cleaning solutions being left out, unattended, and accessible to residents in care on a Case Management - Legal/Non-Compliance visit dated 8/12/2025.

Exit interview conducted over the phone with Licensee and the Caregiver present at the facility, deficiencies cited on LIC809-D pages, a civil penalty in the amount of $250 for a repeat violation is being assessed on the LIC421FC, report signed, report and appeal rights provided to the Caregiver.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20250922190818
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: IRENE'S BOARD & CARE
FACILITY NUMBER: 405800987
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/26/2025
Section Cited
CCR
87309(a)
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Storage Space and Access (a) ...the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives,...sharp objects,... and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
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Licensee states they will re-train the staff on this regulation and create log sheets to record the date, time and reason for every time staff unlock and lock any locked cabinets containing disinfectants, cleaning solutions, poisonous substances, knives, and sharp objects. Licensee will email
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This requirement was not met as evidenced by: Based on observation, the licensee did not follow this regulation when they left disinfectants, cleaning solutions, knives, and sharp objects out and accessible to residents in care which poses an immediate Health and Safety risk to persons in care.
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LPA training documents and signed staff roster on or before 9/26/2025 and the log on or before 10/03/2025.
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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: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5