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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801505
Report Date: 01/29/2026
Date Signed: 01/29/2026 02:40:00 PM

Unsubstantiated


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
12/17/2025 and conducted by Evaluator Erica Mosley
COMPLAINT CONTROL NUMBER: 29-AS-20251217145251
FACILITY NAME:FAMILYCARE COTTAGE ONEFACILITY NUMBER:
565801505
ADMINISTRATOR:MARISOL FLAMENCOFACILITY TYPE:
740
ADDRESS:820 CALLE CEDROTELEPHONE:
(805) 492-1200
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:6CENSUS: 3DATE:
01/29/2026
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Magdalena "Maggy" Garcia - Assistant AdministratorTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Facility staff refused to return resident's personal items upon move out
Facility staff did not allow resident's authorized person to make decisions regarding resident's care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced subsequent complaint visit to investigate the above-listed allegations. The purpose of this visit is to deliver findings for the above listed allegations. Upon arrival at approx. 1:15 p.m. LPA was greeted by staff who called the Administrator and the reason for the visit was explained. The LPA met with Magdalena "Maggy" Garcia, Assistant Administrator (AA) and reason for the visit was explained. Entrance interview conducted.
On 12/17/2025, the Department received a complaint regarding the following allegations, Facility staff refused to return resident's personal items upon move out and Facility staff did not allow resident's authorized person to make decisions regarding resident's care. On 12/19/2025 starting at 1:13 p.m. LPA and staff briefly toured the physical plant areas inside and outside, starting at 1:30 p.m. and throughout the visit LPA conducted three (3) in-person, staff interviews, conducted a file and record review for Resident #1 (R1), at 2:54 p.m. conducted a telephonic interview with Power of Attorney (POA) #1 and obtained copies of pertinent documentation relevant to the investigation. Report continued on LIC 9099-C PAGE 2...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
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 4
Control Number 29-AS-20251217145251
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: FAMILYCARE COTTAGE ONE
FACILITY NUMBER: 565801505
VISIT DATE: 01/29/2026
NARRATIVE
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(PAGE 2) Report continued from LIC 9099...

On 01/13/2026 conducted the following telephonic interviews at 3:20 p.m. with Facility owner, at 3:47 p.m. with Long Term Care Ombudsman (LTCO), at 3:52 p.m. with Power of Attorney (POA) #2 at 3:04 p.m. and at 3:06 p.m. attempted to contact POA #1 on mobile and home phone numbers. On 01/27/2026 conducted the following telephonic interviews at 2:46 p.m. with facility Administrator at 3:58 p.m. with relocated facility Administrator.

During today's visit starting at 1:20 p.m. LPA and staff briefly toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, and obtained copies of pertinent documentation relevant to the investigation.

On the allegation, Facility staff refused to return resident's personal items upon move out, it is the concern of the Reporting Party (RP) that the facility refused to release R1’s personal belongings, including furniture, clothing, wallet, and television. To investigate this complaint, LPA conducted in person interviews, telephonic interviews, file and record review and obtained copies of pertinent documentation relevant to the investigation.

Interviews with POA #2 revealed that on 12/12/2025, they became the POA for R1, revoking the POA status of POA #1. On 12/16/2025, POA #2 texted the POA paperwork to the facility AA. Later that morning, POA #2 arrived at the facility and informed the AA that R1 would be moving out. POA #2 stated that the AA did not respond to the text message but acknowledged receiving the document during the move-out process. At that time, large furniture items were not released, and POA #2 left the facility with R1. On 01/13/2026, POA #2 confirmed that all items were picked up by the relocated facility on 12/19/2025.

Interview with POA #1 revealed that they obtained POA for R1 on 12/10/2012. POA #1 provided a letter from R1’s neurologist dated 11/03/2025, stating that R1 currently lacks the capacity to make independent financial and medical decisions. POA #1 indicated that they are currently involved in litigation to resolve the POA status for R1. Additionally, they were advised that their attorney will contact the facility to provide recommendations regarding the furniture and will follow the appropriate guidelines on how to proceed.

Report continued on LIC 9099-C PAGE 3...

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20251217145251
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: FAMILYCARE COTTAGE ONE
FACILITY NUMBER: 565801505
VISIT DATE: 01/29/2026
NARRATIVE
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(PAGE 3) Report continued from LIC 9099-C page 2...

Interviews with facility administrative staff revealed that R1 was admitted to the facility on 11/14/2025 by POA #1 and moved out on 12/16/2025 by POA #2. The Administrator Assistant (AA) stated that on the morning of 12/16/2025, POA #2 texted them a document. At approximately 8:40 a.m., POA #2 arrived at the facility and informed the AA that they had sent updated POA documentation and were now the POA for R1. POA #2 also stated that R1 would be moving out that day and began the move-out process. The facility was unsure how to proceed and contacted POA #1, Adult Protective Services (APS), the Long-Term Care Ombudsman (LTCO), and licensing for guidance. APS arrived on-site and advised the facility that the matter was civil and should be handled by the attorneys. POA #1 informed the facility that they were unaware of any changes regarding R1’s POA status and noted that they had previously submitted documentation from R1’s neurologist stating that R1 was not capable of making informed decisions, which was the basis for the POA being in place. The facility owner stated they were uncertain about the validity of the updated POA documentation since it was only texted that morning. During the move-out, POA #2 and Witness #1 (W1) became aggressive, shouting at staff and banging on walls and doors. The facility owner contacted law enforcement, after which POA #2 and R1 left, leaving large furniture items behind. Law enforcement advised the facility that the situation was a civil matter and to await attorney guidance regarding the remaining items. Administrative staff reported that later that same day, the relocated facility’s Administrator called to schedule a pickup. The facility owner stated that they coordinated the pickup and confirmed that the items were collected, noting that having the relocated facility retrieve the items was the best solution since they knew the items were going to R1.

Interview with the LTCO revealed that R1’s personal belongings were in their possession on the day R1 moved into the relocated facility. The only items not obtained at that time were large furniture pieces; however, these were later recovered by the relocated facility.

Files and records reviewed revealed that R1 moved into the facility on 11/14/2025. POA documentation dated 12/10/2012 lists POA #1. A neurologist’s letter dated 11/03/2025 indicates that R1 carries a diagnosis of Alzheimer’s disease and currently lacks the capacity to make independent financial and medical decisions. POA documentation dated 12/12/2025 lists POA #2. Facility records indicate that R1’s belongings were released to the relocated facility on 12/23/2025.

Report continued on LIC 9099-C PAGE 4...

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20251217145251
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: FAMILYCARE COTTAGE ONE
FACILITY NUMBER: 565801505
VISIT DATE: 01/29/2026
NARRATIVE
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(PAGE 4) Report continued from LIC 9099-C page 3...

Although the allegation may have happened or are valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegations of Facility staff refused to return resident's personal items upon move out is deemed unsubstantiated at this time.

On the allegation, Facility staff did not allow resident's authorized person to make decisions regarding resident's care it is the concern of the Reporting Party (RP) that the facility did not include POA#2 in care decisions for R1. To investigate this complaint, LPA conducted in person interviews, telephonic interviews, file and record review and obtained copies of pertinent documentation relevant to the investigation.

Interviews with POA#2 revealed that they obtained POA for R1 on 12/12/2025. Prior to that date, POA#1 held the authority. R1 was admitted to the facility on 11/14/2025, and all documentation and care planning were completed with POA#1. On the morning of 12/16/2025, POA#2 texted the AA the POA documentation. Around 8:40 a.m., POA#2 arrived at the facility and informed staff that R1 would be moving out. On 01/13/2026, POA#2 stated they were unaware of any care planning, as R1 had moved out on 12/16/2025.

Interviews with facility administrative staff confirmed that R1 was admitted on 11/14/2025 and all documentation and care planning were completed with POA#1. On 12/16/2025, the AA received a text message from POA#2 with the POA document. That same day, facility staff were informed that R1 would be moving out and noted the updated POA status to the AA. All of R1’s care planning was completed upon admission on 11/14/2025. No additional care planning was conducted on or after 12/16/2025. Although the allegation may have happened or are valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Facility staff did not allow resident's authorized person to make decisions regarding resident's care is deemed unsubstantiated at this time.

Exit interview conducted. Report was reviewed and a copy was provided.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4