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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609935
Report Date: 08/26/2026
Date Signed: 08/26/2026 02:09:44 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
06/22/2026 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20260622171340
FACILITY NAME:LAKESIDE VIEW ELDERLY CAREFACILITY NUMBER:
197609935
ADMINISTRATOR:DUENAS, RALPHFACILITY TYPE:
740
ADDRESS:14003 LAKESIDE STTELEPHONE:
(818) 288-5869
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:6CENSUS: 4DATE:
08/26/2026
UNANNOUNCEDTIME BEGAN:
08:22 AM
MET WITH:Trisha Hidalgo - Licensee AdministratorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Facility is operating without an administrator.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met Licensee Representative Trisha Hidalgo and explained the reason for the visit.

LPA conducted physical plant tour at 9:02 AM and requested copies of facility document relevant to the investigation at 9:34 AM and interviewed staff resident between 9:45 AM to 1:00 PM. Regarding the allegation that Facility is operating without an administrator, it was alleged that the current Administrator on Record has no presence at the facility and the designated Administrator left out of the country. LPA's interview with the Licensee Representative revealed that the Administrator on record did not work on this facility and was never changed on record. LPA's interview with the designee also confirmed that the designee left the country and so with the alternate Administrator. Based on the information gathered during this and prior visit, this allegation is deemed substantiated at this time. Citation issued. Exit interview conducted. Copy of this report issued
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
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)
Page: 1 of 4
Control Number 31-AS-20260622171340
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LAKESIDE VIEW ELDERLY CARE
FACILITY NUMBER: 197609935
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/02/2026
Section Cited
CCR
87405(a)
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All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation.
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The License agreed to designate a new Administrator and submit it to CCL on or before the POC date.
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This requirement is not met as evidenced by:

Based on observation and interview, there was a time at the facility that no Administrator was present, this poses a potential health and safety and personal rights risk to the residents 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.
SUPERVISOR'S NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
06/22/2026 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20260622171340

FACILITY NAME:LAKESIDE VIEW ELDERLY CAREFACILITY NUMBER:
197609935
ADMINISTRATOR:DUENAS, RALPHFACILITY TYPE:
740
ADDRESS:14003 LAKESIDE STTELEPHONE:
(818) 288-5869
CITY:SYLMARSTATE:CAZIP CODE:
91342
CAPACITY:6CENSUS: 4DATE:
08/26/2026
UNANNOUNCEDTIME BEGAN:
08:22 AM
MET WITH:Trisha Hidalgo - Licensee AdministratorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not prevent facility from being in financial distress.

Staff financially abused a resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met Licensee Representative Trisha Hidalgo and explained the reason for the visit.

LPA conducted physical plant tour at 9:02 AM and requested copies of facility document relevant to the investigation at 9:34 AM and interviewed staff resident between 9:45 AM to 1:00 PM. Regarding the allegation that Staff did not prevent facility from being in financial distress, it was alleged that the current operator who claimed that the facility does not have reasonable and sufficient financial resources to operate the facility. LPA's interview with the current operator today between 9:45 AM to 1:00 PM revealed that the operator always has sufficient funds to operate the facility and denied telling that anyone about having no sufficient fund to operate the facility but had mentioned that it is hard to survive financially with only half of the capacity. (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
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)
Page: 3 of 4
Control Number 31-AS-20260622171340
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LAKESIDE VIEW ELDERLY CARE
FACILITY NUMBER: 197609935
VISIT DATE: 08/26/2026
NARRATIVE
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(continued from LIC 9099-A)

Regarding the allegation that Staff financially abused a resident in care, it was alleged that Resident #1 (R1)'s portion of the rent check bounced but record shows that,. it was debited. LPA's record review today at 11:45 AM, revealed that the check in question actually bounced and needed to be replaced because R1's signature was not recognized by the bank. The check payment issue was eventually resolved.

Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
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)
Page: 4 of 4