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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610025
Report Date: 01/22/2025
Date Signed: 01/22/2025 01:14:43 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
01/21/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250121100857
FACILITY NAME:PACIFICA SENIOR LIVING NORTHRIDGEFACILITY NUMBER:
197610025
ADMINISTRATOR:KAREN MARINFACILITY TYPE:
740
ADDRESS:8700 LINDLEY AVENUETELEPHONE:
(818) 886-5181
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:110CENSUS: 74DATE:
01/22/2025
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Irina Selezne, Resident Services DirectorTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Licensee not ensuring there is a written plan of activities available to residents
INVESTIGATION FINDINGS:
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On 01/22/25, at 10:35am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Irina Selezne, Resident Services Director. LPA explained the purpose of this visit was to gather information, interview staff and residents and deliver findings for this complaint.

On 01/22/25, LPA Saucedo asked for the census, staff, and resident rosters. On 01/22/25, LPA Saucedo conducted a physical tour and interviewed staff and residents.

LIC 9099C-continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
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-20250121100857
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: PACIFICA SENIOR LIVING NORTHRIDGE
FACILITY NUMBER: 197610025
VISIT DATE: 01/22/2025
NARRATIVE
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Regarding the allegation: Licensee not ensuring there is a written plan of activities available to residents. It is being alleged that there has not been a planned activities calendar since October 2024. During LPA's physical tour, LPA observed a planned activities for the month of January 2025 and daily planned activity brochures. In addition, LPA observed staff that was recently hired conducting an exercise group with about fifteen (15) residents. LPA confirmed the activity being conducted with the daily activities brochure date and time for accuracy. LPA interviewed two (2) staff that confirmed there is daily activities for the residents that want to attend and the activities for the month of January 2025 is displayed. LPA interviewed seven (7) residents that confirmed there is different activities everyday. Therefore, based on the LPA's observations, staff and resident interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.


An exit interview was conducted, no citation(s) were issued for the above allegation(s), and a copy of this report was given to the Administrator.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2