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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850242
Report Date: 11/14/2025
Date Signed: 11/14/2025 04:24:28 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
11/07/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20251107111518
FACILITY NAME:NAVITA RESIDENCES EDGEMONTFACILITY NUMBER:
565850242
ADMINISTRATOR:SHILA PANDEYFACILITY TYPE:
740
ADDRESS:1690 EDGEMONT DRTELEPHONE:
(805) 413-2455
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:6CENSUS: 5DATE:
11/14/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Shila PandeyTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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9
Staff do not treat resident with dignity or respect
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Valeria Conway conducted a 10-day initial complaint visit to address the allegations listed above. LPA arrived at 9:40 A.M. and met with facility staff, Mis “Nana” Sunariyati, who contacted via telephone facility administrator. At 10:15 A.M. Facility Designee Karthiga (Karthi) Vijayakumar and Administrator, Shila Pandey arrived at the facility. Entrance interview conducted.

During today’s visit, the LPA conducted a brief plant tour at 10:20 A.M. to ensure there are no health and safety concerns, conducted interviews with the Administrator and facility designee, two (2) staff members, and three (3) residents. Between 10:00 A.M. and 2:30 P.M., conducted a resident file review, and obtained copies of pertinent documents relevant to the investigation. The following was then determined:

Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025
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
11/07/2025 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20251107111518

FACILITY NAME:NAVITA RESIDENCES EDGEMONTFACILITY NUMBER:
565850242
ADMINISTRATOR:SHILA PANDEYFACILITY TYPE:
740
ADDRESS:1690 EDGEMONT DRTELEPHONE:
(805) 413-2455
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:6CENSUS: 5DATE:
11/14/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Shila PandeyTIME COMPLETED:
04:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure that resident's grooming needs were met
INVESTIGATION FINDINGS:
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2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Valeria Conway conducted a 10-day initial complaint visit to address the allegations listed above. LPA arrived at 9:40 A.M. and met with facility staff, Mis “Nana” Sunariyati, who contacted via telephone facility administrator. At 10:15 A.M. Facility Designee Karthiga (Karthi) Vijayakumar and Administrator, Shila Pandey arrived at the facility. Entrance interview conducted.

During today’s visit, the LPA conducted a brief plant tour at 10:20 A.M. to ensure there are no health and safety concerns, conducted interviews with the Administrator and facility designee, two (2) staff members, and three (3) residents. Between 10:00 A.M. and 2:30 P.M., conducted a resident file review, and obtained copies of pertinent documents relevant to the investigation. The following was then determined:
Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025
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-20251107111518
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: NAVITA RESIDENCES EDGEMONT
FACILITY NUMBER: 565850242
VISIT DATE: 11/14/2025
NARRATIVE
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Continued on LIC 9099

Regarding the allegation that "Staff did not ensure that resident's grooming needs were met", the reporting party (RP) expressed concern that residents are not being kept groomed. During today’s visit, LPA inspected all residents’ rooms and did not detect any foul odors. An interview with a visiting nurse revealed that they have not observed the resident under their care to be unkempt or inadequately groomed. In addition, LPA interviewed four (4) out of five (5) residents and observed their nails, hair, and clothing. LPA did not observe any residents to be unkempt. One (1) resident stated that staff occasionally forget to shave them; however, when they request assistance with shaving, staff complete the task without issue. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegations “Staff did not ensure that resident's grooming needs were met” is deemed Unsubstantiated at this time.

Exit interview conducted and copy of report provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20251107111518
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: NAVITA RESIDENCES EDGEMONT
FACILITY NUMBER: 565850242
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/25/2025
Section Cited
CCR
87468.1(a)(1)
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87468.1 Personal Rights of Residents in All Facilities (a) (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.
This requirement is not met as evidenced by:
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Administrator will hire a third-party service to train staff on personal rights and dementia and submit proof of training to CCL before POC due date.
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Based on interview, residents report staff occasionally handled them rough and occasionally yelling at the residents, which poses an immediate 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: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 29-AS-20251107111518
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: NAVITA RESIDENCES EDGEMONT
FACILITY NUMBER: 565850242
VISIT DATE: 11/14/2025
NARRATIVE
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Continued from LIC 9099

Regarding the allegation that “Staff does not treat resident with dignity or respect”, the reporting party expressed concern that Staff #1 (S1) yelled at residents in care and handled them in a rough manner. Staff interviewed denied these allegations and stated that they treat all residents with respect. However, interviews with residents indicated that on some occasions S1 may have handled residents roughly while providing incontinence care or changing them. Residents also reported witnessing staff raise their voices when residents were “not being cooperative”. Additionally, R1 informed LPA that staff turn off their television at 8:00 P.M. every night and take the remote control until the following morning. R1 further stated that when the television is turned off and they are unable to sleep, they would prefer to listen to music, but staff keep their radios away from them. According to R1, staff do this, so neither the radio nor the television disturb other residents. LPA observed R1’s room and observed their radio on the floor face down and out of R1’s reach. The administrator stated that R1’s family authorized staff to keep the television remote controls secured because R1 will otherwise remain awake throughout the night Per administrator, when resident doesn't rest it results in health issues the following day. During today’s visit, LPA observed a resident requesting assistance from a staff member. The staff member responded in an unfriendly manner, stating “I am busy”, and walked away without providing assistance. LPA explained to the administrator the importance of using alternative approaches when a staff member is occupied, to ensure residents are addressed respectfully and their needs are acknowledged. LPA requested the most recent in-service training records regarding residents’ personal rights. The administrator provided documentation of the training, however, during interviews, staff stated that they had not received this training. Based on the information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation of “ “Staff does not treat resident with dignity or respect”, has been SUBSTANTIATED at this time.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties.

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

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5