197609500-8-11-2026-31-AS-NGID-DXRT6F-20260909142700

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609500
Report Date: 08/11/2026
Date Signed: 08/11/2026 02:36:53 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
08/06/2026 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20260806082953

FACILITY NAME:	DEVONSHIRE ELDERLY CARE		FACILITY NUMBER:	197609500
ADMINISTRATOR:	BANGASH, FARAH		FACILITY TYPE:	740
ADDRESS:	17441 DEVONSHIRE STREET		TELEPHONE:	(310) 955-0674
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	6	CENSUS: 6	DATE:	08/11/2026
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Maria Bangash, House Manager		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff does not ensure facility is kept free of pests for residents in care.
Staff does not ensure food is kept free of foreign objects.
Staff had inappropriate conversations with resident in care.

INVESTIGATION FINDINGS:

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At 9:45 AM, Licensing Program Analyst (LPA) Huma Rahimi, conducted an unannounced initial complaint visit to investigate the above stated allegations. LPA met with Staff #1 (S1) who granted access to the facility. S1 contacted the House Manager via telephon and LPA explained the reason for the visit.

During course of the investigation, interviews and record review were made. At 9:55 AM, LPA requested client and staff roster. At 10:05 AM, LPA requested copies of pertinent information which include, but not limited to Physician Report, Admission Agreement, Appraisal Needs and Services Plan,the pest-control product purchase receipt, and ect., relevant to the course of investigation. At 10:15 AM, LPA conducted a physical plant tour. Between 10:25 AM - 12:25 PM, LPA conducted an interview with the House Manager, two (2) staff members (S1 & S2), and six (6) out of (6) residents.
Continue on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2026

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 31-AS-20260806082953

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: DEVONSHIRE ELDERLY CARE	FACILITY NUMBER: 197609500
	VISIT DATE: 08/11/2026

NARRATIVE

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Allegation: Staff does not ensure facility is kept free of pests for residents in care.

It was alleged that the facility had a cockroach infestation while R1 lived at the home. To investigate this allegation, LPA interviewed the House Manager, two (2) staff members, and six (6) residents, and conducted a tour of the facility, including the kitchen and bathrooms. The House Manager and S1 confirmed that cockroaches and ants were observed in September 2025, and that R1 reported seeing cockroaches. Staff stated that insect-control powder was purchased and applied in the areas of concern. Furthermore, S2 is responsible for cleaning and sanitation of the facility and reported to LPA that S2 had not observed any insect infestation during the four (4) months of employment.

All six (6) residents interviewed denied seeing cockroaches or other pests at the facility. During the facility tour, LPA did not observe cockroaches, signs of an active infestation, or other evidence of pests.

Based on interviews and LPA's observations, there was insufficient evidence to show that the facility failed to address the reported pest concern. Therefore, this allegation is Unsubstantiated at this time.

Allegation: Staff does not ensure food is kept free of foreign objects.

It was alleged that R1 found two (2) pieces of glass in his/her food. To investigate this allegation, LPA interviewed the House Manager, two (2) staff members, and six (6) residents. The House Manager stated R1 did not report finding glass in food but reported vomiting, an insect concern, and a toe injury on 09/24/2025. The House Manager stated R1 was offered medical assistance and the facility notified Home Health regarding the toe injury. During today’s visit, LPA was shown a photograph of R1's bandaged toe. S1 and S2 stated they were not aware of any incident involving glass in R1's food.

All six (6) residents interviewed denied finding foreign objects in their food or hearing about an incident involving glass in a resident's food.

Based on interviews and information obtained, there was insufficient evidence to confirm that glass was found in R1's food or that the facility failed to keep food free of foreign objects. Therefore, this allegation is Unsubstantiated at this time.

Continue on LIC 9099C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 31-AS-20260806082953

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: DEVONSHIRE ELDERLY CARE	FACILITY NUMBER: 197609500
	VISIT DATE: 08/11/2026

NARRATIVE

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Allegation: Staff had inappropriate conversations with resident in care

It was alleged that staff offered R1 $30,000 to marry a family member and elope to Las Vegas so the family member could remain in the country. To investigate this allegation, LPA interviewed the House Manager, two (2) staff members, and six (6) residents.

The House Manager, S1, and S2 denied knowledge of the alleged $30,000 offer, marriage proposal, or conversations involving immigration. They also denied observing inappropriate conversations involving R1. Furthermore, interviewed with six (6) residents denied hearing or observing inappropriate conversations involving money, marriage, immigration, or complaints.

Based on interviews and information obtained, there was insufficient evidence to confirm that the $30,000 offer or inappropriate conversations occurred. Therefore, this allegation is Unsubstantiated at this time.

Exit interview conducted and appeal rights explained.

Copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2026

LIC9099 (FAS) - (06/04)

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