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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609496
Report Date: 01/17/2025
Date Signed: 01/17/2025 04:01:05 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
01/16/2025 and conducted by Evaluator Antonia Alvizar-Ettima
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250116132313
FACILITY NAME:ENCINO TERRACE SENIOR LIVINGFACILITY NUMBER:
197609496
ADMINISTRATOR:JANNAT, SHAHRZADFACILITY TYPE:
740
ADDRESS:16025 VENTURA BLVDTELEPHONE:
(818) 986-8466
CITY:ENCINOSTATE: CAZIP CODE:
91436
CAPACITY:85CENSUS: 59DATE:
01/17/2025
UNANNOUNCEDTIME BEGAN:
03:31 PM
MET WITH:Vice President of Operations (VPO), Joel SchochetTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff did not prevent resident from causing injuries to another resident in care
INVESTIGATION FINDINGS:
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At 10:15a.m. Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced initial visit to investigate the above stated allegation. LPA met with the VPO and explained the reason for the visit.

At 10:30a.m. LPA Alvizar-Ettima requested the staff, and facility residents’ roster, as well as the rosters for residents that temporarily were relocated in this facility due to Eaton Fire. At 10:45a.m.LPA Alvizar-Ettima and VPO conducted physical plant tour. Between 10:50a.m. – 11:20a.m. LPA conducted interviews with VPO and staff. LPA asked questions relevant to the nature of the complaint. In addition, at 11:53a.m. LPA reviewed available rosters for facility residents and temporality relocated residents.

Staff did not prevent resident from causing injuries to another resident in care.
It was alleged that the resident #1 (R1) has been seen with a cut on their arm and multiple bruises on body,caused by resident #2 (R2).
Cont. LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025
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-20250116132313
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: ENCINO TERRACE SENIOR LIVING
FACILITY NUMBER: 197609496
VISIT DATE: 01/17/2025
NARRATIVE
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LPAs interviews with administrative personnel, Caregivers and Med-Tech revealed they have not seen a resident with a cut and multiple bruises. R1 and R2 are not resident of the facility. They maybe residents that were temporarily relocated at this facility due to Eaton Fire. At the time of this visit, LPA attempt to interview temporarily relocated residents. However, they were no longer at the facility. During investigation, LPA did not observe residents with a cut and multiple bruises on body in the facility. LPA reviewed facility resident roster, temporarily relocated resident roster and R1, and R2’s names were not there.

Based on observation, interviews and record review it was concluded that although the allegation may have happened, there is no pertinent information to verify validity of the complaint. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazard is noted during this visit.
Exit Interview conducted. Copy of report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2