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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801505
Report Date: 03/04/2026
Date Signed: 03/04/2026 02:34:29 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
02/12/2026 and conducted by Evaluator Erica Mosley
COMPLAINT CONTROL NUMBER: 29-AS-20260212110309
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: DATE:
03/04/2026
UNANNOUNCEDTIME BEGAN:
10:12 AM
MET WITH:Debra Bryant - Licensee Representative
Magdalena "Maggy" Garcia - Assistant Administrator
Marisol Flamenco - Administrator		TIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Licensee did not provide responsible party with a refund as required
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced subsequent complaint visit to investigate the above-listed allegation. Upon arrival at approx. 10:12a.m. LPA was greeted by staff who called the Administrator and the reason for the visit was explained. The LPA met with Debra Bryant, Licensee Representative, Marisol Flamenco, Administrator and Magdalena "Maggy" Garcia, Assistant Administrator, and reason for the visit was explained. Entrance interview conducted.

On 02/12/2026, the Department received a complaint regarding the following allegation, Licensee did not provide responsible party with a refund as required. On 02/12/2026 LPA Esther Cortez conducted an unannounced initial complaint visit, conducted a physical plant tour, conducted three (3) in-person, staff interviews, a file review for Resident #1 (R1), and obtained copies of pertinent documentation relevant to the investigation.
Report continued on LIC 9099-C PAGE 2...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
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 3
Control Number 29-AS-20260212110309
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: 03/04/2026
NARRATIVE
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(PAGE 2) Report continued from LIC 9099...

During today's visit starting at 10:20 a.m. LPA and staff briefly toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, starting at 10:35 a.m. conducted two (2) telephonic interviews with the Parties Responsible (PR) for R1, at 11 a.m. conducted an in-person interview with the facility Administrator, at 1:20 p.m. conducted an in person interview with the facility Licensee representative and obtained copies of pertinent documentation relevant to the investigation.

On the allegation, Licensee did not provide responsible party with a refund as required, it is the concern of the Reporting Party (RP) that R1’s PR did not receive the refund check within the required 15 days after the room was vacated. 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.

File and Record review revealed that R1 moved into the facility on 09/18/2017, passed away on 11/08/2025, and moved out on the same day 11/08/2025.

Administrative staff interviews revealed that R1 moved into the facility on 09/18/2017, passed away on 11/08/2025 and move out on the same date. To their knowledge the facility has a bookkeeper who handles all facility finances. To their knowledge R1 was paying $6,200 monthly for room and board and an additional $300 for incontinent supplies. There is an ongoing unrelated legal matter with the same family and to their knowledge it is the reason why the refund has not been issued. As of today, the refund has not been issued.

Interview with the facility licensee representative revealed that there is an ongoing unrelated legal matter with the R1’s family. Due to the legal matter, they believe they should not have to pay the refund since they are still owed money by the family. Interviews with PR revealed that they have tried numerous times to get in contact with the facility owner, however, have been unsuccessful. They are aware of an unrelated matter with their family members, however, note that it is unrelated to R1 and their refund.

Based on information gathered during the course of the investigation, and interviews there is sufficient evidence to support the allegation occurred. Therefore, the allegation of Licensee did not provide responsible party with a refund as required is deemed SUBSTANTIATED at this time. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiency was cited (refer to LIC 9099-D.) Administrator was informed that failure to correct the deficiency may result in civil penalties.

Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.

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

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20260212110309
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/18/2026
Section Cited
HSC
1569.652(c)
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§1569.652 Termination of admission agreement upon death of resident... and refunds (c) A refund of any fees paid in advance...shall be issued...to the resident’s estate, within 15 days after the personal property is removed.This requirement is not met as evidenced by
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Licensee representative will issue a refund for the amount of $4,546.66 based on the $6,200 paid montly for room and board by POC due date.
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Based on interviews and record review, the facility did not comply with the above cited section, as R1 passed away on 11/08/25, belongings were removed on 11/08/25 and no check has been issued, which poses a potential personal rights risk to persons 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: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3