197609500-8-26-2026-31-AS-NGID-DXRT6E-20260909142658

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609500
Report Date: 08/26/2026
Date Signed: 08/26/2026 10:20:38 AM

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:	08/26/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Farrah Siddiqui, Staff		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

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Staff bribed resident in exchange for not reporting complaints.

INVESTIGATION FINDINGS:

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At 9:30 am, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced subsequent complaint visit to investigate the above stated allegation. LPA met with the Staff #1 (S1) Farrah Siddiqui and the House Manager was contacted via telephone. LPA explained the reason of the vist. The House Manager informed LPA that they are unable to come to the facility and designated the staff to sign and receive today's report.

To investigate the allegation above LPA conducted an initial visit on 08/11/2026. LPA obtained copies of client and staff roster and other pertinent information including but not limited to Physician’s Report, Admission Agreement, Appraisal Needs and Services Plan, the pest-control product purchase receipt, and etc., relevant to the course of investigation. LPA conducted a physical plant tour.Interviews were conducted with the House Manager, two (2) staff members (S1 & S2), and six (6) out of six (6) residents. Continue on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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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: 08/26/2026

NARRATIVE

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Allegation: Staff bribed resident in exchange for not reporting complaints.

It was alleged that facility staff offered or provided R1 with money in exchange for not reporting complaints against the facility. To investigate this allegation, LPA interviewed the House Manager, two (2) staff members, and six (6) residents.

The House Manager denied offering or providing R1 with money and stated that, after R1 moved out, R1 requested $10,000 and threatened to take the facility to court regarding the reported insect issue. The House Manager denied providing any money or instructing R1 not to report complaints.

S1 denied knowledge of any payment or agreement involving R1. S2 stated that S2 began working at the facility approximately four (4) months ago, after R1 had moved out, and therefore had no knowledge of interactions between R1 and facility staff. S2 also reported no knowledge of any current residents being offered money in exchange for not reporting complaints.

The six (6) residents interviewed did not report hearing or observing any arrangement involving payment to R1 in exchange for not reporting complaints.

Based on interviews and information obtained, there was insufficient evidence to establish that facility staff offered or provided money to R1 in exchange for not reporting complaints. Therefore, this allegation is deemed 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: 08/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2026

LIC9099 (FAS) - (06/04)

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