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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608838
Report Date: 09/26/2025
Date Signed: 09/26/2025 03:26:33 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.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
12/13/2024 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20241213122323
FACILITY NAME:VILLAGE AT NORTHRIDGE, THEFACILITY NUMBER:
197608838
ADMINISTRATOR:THOMAS REKOWSKIFACILITY TYPE:
740
ADDRESS:9222 CORBIN AVETELEPHONE:
(818) 350-2951
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:194CENSUS: 164DATE:
09/26/2025
UNANNOUNCEDTIME BEGAN:
11:02 AM
MET WITH:Mary Okhata-TIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not properly address resident's multiple falls at facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced subsequent complaint visit to include additional interviews for the Substantiated complaint report on 12/30/2024. LPA arrived and was greeted by the receptionist and met with the Assisted Living Director Mary Okahata, and explained the reason for the visit. LPA requested copies of pertinent information, which includes LIC 500 and the Resident Roster. LPA conducted a physical plan tour to ensure the health and safety of the residents are protected and are in compliance with Title 22 Regulations. During today's visit, LPA interviewed an additional 5 residents, 3 staff member, and the Executive Director. Based on information obtained, the allegation remains Substantiated at this time. Facility staff did not properly address multiple falls at the facility. Resident#1(R1) Service Plan acknowledges that R1 is a fall risk; however did not address actions taken to prevent future falls. R1 had 18 fall incidents at the facility from January to December 2024. Exit interview conducted, POC is cleared, copy of this report signed and delivered.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025
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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