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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850316
Report Date: 08/06/2026
Date Signed: 08/06/2026 05:23:07 PM

Unsubstantiated


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
04/27/2026 and conducted by Evaluator Erica Mosley
COMPLAINT CONTROL NUMBER: 29-AS-20260427135616
FACILITY NAME:HAPPY HOME CARE SIDLEEFACILITY NUMBER:
565850316
ADMINISTRATOR:ROSALES, KARENFACILITY TYPE:
740
ADDRESS:174 SIDLEE STREETTELEPHONE:
(818) 219-5998
CITY:THOUSAND OAKSSTATE: ZIP CODE:
91360
CAPACITY:6CENSUS: 4DATE:
08/06/2026
UNANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Karina Antig - Facility DesigneeTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Facility staff did not respond appropriately during an emergency
Facility did not maintain resident's emergency documents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced subsequent complaint visit to investigate the above listed allegations. Upon arrival at approx. 10:22 a.m. LPA was greeted by staff who called the Administrator to inform them of the visit. The facility Designee / Assistant Administrator (AA), Karina Antig arrived shortly after and the reason for the visit was explained. Entrance interview.
On 04/24/2026 the department received a complaint regarding the following allegations Facility staff did not respond appropriately during an emergency and Facility did not maintain resident's emergency documents. On 05/05/2026 LPA Mosley conducted the initial 10 day visit starting at 9:40 a.m. LPA and staff toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, and facility is in compliance with Title 22 Regulations. Starting at 10:09 a.m. and throughout the visit LPA conducted four (4) staff interviews, attempted to interview Resident #1 (R1), a file and record review for R1 and obtained copies of pertinent documents relevant to the investigation.
Report continued on LIC 9099-C PAGE 2...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
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 3
Control Number 29-AS-20260427135616
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: HAPPY HOME CARE SIDLEE
FACILITY NUMBER: 565850316
VISIT DATE: 08/06/2026
NARRATIVE
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(PAGE 2) Report continued from LIC 9099...
During today's visit starting at 10:33 a.m. LPA and staff toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, and facility is in compliance with Title 22 Regulations. At 2:50 p.m. conducted a telephonic interview with the power of attorney (POA) of Resident #1 (R1). At 3:16 p.m. conducted an interview with R1 at 3:30 p.m. conducted an interview with Resident #2 (R2). On the allegation, Facility staff did not respond appropriately during an emergency, it is the concern of the Reporting Party (RP) that the facility staff were unable to effectively communicate with emergency personnel. To investigate this complaint, LPA conducted in person interviews, file and record review and obtained copies of pertinent documentation relevant to the investigation.

Staff interviews revealed that during the time frame of the complaint, R1 was experiencing a change in condition and was transported to the hospital via ambulance on 04/23/26. R1 returned from the hospital on 04/26/26, and their POA brought them home without providing any discharge paperwork. The following morning, on 04/27/26 at approximately 7:00 a.m., R1 appeared lethargic and was unresponsive, prompting staff to call 911. Staff stated they were able to communicate with paramedics; however, they were unable to provide specific information regarding R1’s recent hospitalization because the POA retained the discharge documents. Staff reported they responded appropriately during the emergency with the information they had. Interview with R1 revealed that due to cognitive decline, they are unable to recall the specific event. R1 stated that the facility staff treat them well. R1 is able to communicate effectively with all staff in English and reported having no concerns.

Interview with R2 revealed that the facility staff treat them well. R2 stated they have no issues communicating with any of the staff and are able to communicate effectively in English. R2 expressed no concerns regarding the care they receive and reported that, based on their observations, staff have acted appropriately during emergency situations. Interview with the POA revealed that they are able to communicate with facility staff and have no difficulty doing so. The POA stated they believe the facility staff acted appropriately during the emergency involving R1. Record reviews, including but not limited to the staff schedule, revealed that on the day of the incident, LPA was able to communicate with all three (3) staff listed on the schedule.

Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Facility staff did not respond appropriately during an emergency is deemed unsubstantiated at this time.

Report continued on LIC 9099-C PAGE 3...

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20260427135616
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: HAPPY HOME CARE SIDLEE
FACILITY NUMBER: 565850316
VISIT DATE: 08/06/2026
NARRATIVE
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(PAGE 3) Report continued from LIC 9099-C PAGE 2...
On the allegation Facility did not maintain resident's emergency documents it is the concern of the reporting party that that facility did not have R1’s accurate emergency information. To investigate this complaint, LPA conducted in person interviews, file and record review and obtained copies of pertinent documentation relevant to the investigation.

Staff interviews revealed that during the time frame of the complaint, R1 was experiencing a change in condition and was transported to the hospital via ambulance on 04/23/26. R1 returned from the hospital on 04/26/26, and their POA brought them home without providing any discharge paperwork. The following morning, on 04/27/26 at approximately 7:00 a.m., R1 appeared lethargic and was unresponsive, prompting staff to call 911. Staff stated they were able to communicate with paramedics; however, they were unable to provide specific information regarding R1’s recent hospitalization because the POA retained the discharge documents. Staff reported they responded appropriately during the emergency with the documentation and information they had.

Interview with the POA revealed that on the evening of 04/26/26, they brought R1 back to the facility after R1 was discharged from the hospital. The POA did not leave the discharge paperwork with facility staff as typically requested. The POA stated that the Facility Designee later called and requested that important paperwork, such as hospital discharge documents, be left at the facility in case of emergencies.



Record review and files, including but not limited to R1’s file, revealed that R1 has a complete file. This includes an identification form (LIC 601), which is typically used for emergency personnel. Additionally, the facility maintained copies of R1’s ID, insurance card, and medication list.

Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Facility did not maintain resident's emergency documents is deemed unsubstantiated at this time. No citations issued at this time. Exit interview conducted. Report was reviewed and a copy was provided.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3