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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610939
Report Date: 05/08/2026
Date Signed: 05/08/2026 12:11:06 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
05/02/2026 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20260502190444
FACILITY NAME:CAPPS CARE HOMEFACILITY NUMBER:
197610939
ADMINISTRATOR:FERNANDO, ANGELAFACILITY TYPE:
740
ADDRESS:8301 CAPPS AVETELEPHONE:
(213) 394-4908
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:6CENSUS: 5DATE:
05/08/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Angela Fernandez-AdministratorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Licensee did not follow proper eviction procedures for resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mariana Agban conducted an initial 10-day complaint visit to investigate the above allegation. LPA met with Administrator Angela Fernando and explained the reason for the visit. At approximately 09:00 am, LPA conducted a physical plant tour. LPA requested copies of pertinent information which includes and not limited to Resident Roster, Resident#1(R1) Physician Report, R1 Admission Agreement, and R1's eviction notice.

Regarding the allegation: Licensee did not follow proper eviction procedures for resident.
It is alleged that Resident #1 (R1) could no longer remain at the facility because R1 is bed bound and the facility does not have bed bound wavier. It was further alleged that R1’s responsible party was asked to sign a document agreeing to relocate R1 within 60 days. LPA interviewed the Administrator, who stated that R1 attended a physician appointment on 04/23/2026, during which R1’s ambulatory status changed from non-ambulatory to bedridden.
(Continue on 9099 C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
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 2
Control Number 31-AS-20260502190444
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: CAPPS CARE HOME
FACILITY NUMBER: 197610939
VISIT DATE: 05/08/2026
NARRATIVE
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The Administrator stated that she discussed R1’s current health status with R1’s responsible party. As a result, a 60-day notice was issued to the responsible party on 04/30/2026 due to R1 requiring a higher level of care and the facility not having an approved bedridden fire clearance. The Administrator further stated that the facility would assist R1’s responsible party with locating an appropriate placement. The Administrator also reported that the 60-day notice was faxed to Community Care Licensing on 04/30/2026. LPA reviewed R1’s Physician’s Report dated 04/23/2026, which confirmed R1’s bedridden status. LPA also reviewed a copy of the 60-day notice issued to the responsible party. Based on interview conducted and records reviewed, there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. LPA discussed the process of obtaining an exception waiver with the Administrator.

Exit interview conducted, copy of this report signed and delivered.
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2