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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610025
Report Date: 03/17/2025
Date Signed: 03/17/2025 01:02:25 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
03/12/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250312143535
FACILITY NAME:NORTHRIDGE VALLEY SENIOR LIVINGFACILITY NUMBER:
197610025
ADMINISTRATOR:KAREN MARINFACILITY TYPE:
740
ADDRESS:8700 LINDLEY AVENUETELEPHONE:
(818) 886-5181
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:110CENSUS: 74DATE:
03/17/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Frances Norberte, Memory Care DirectorTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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Facility staff did not provide adequate supervision to resident in care.
INVESTIGATION FINDINGS:
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On 03/17/25, at 9:20am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Frances Norberte, Memory Care Director. LPA explained the purpose of this visit was to gather information, interview staff and residents and deliver findings for this complaint.

On 03/17/25, LPA Saucedo asked for the census, staff, and resident rosters. On 03/17/25, LPA Saucedo conducted a physical tour and interviewed staff and residents.

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

DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
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 3
Control Number 31-AS-20250312143535
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: NORTHRIDGE VALLEY SENIOR LIVING
FACILITY NUMBER: 197610025
VISIT DATE: 03/17/2025
NARRATIVE
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Regarding the allegation: Facility staff did not provide adequate supervision to resident in care. It is being alleged that resident #1 (R1) is housed in the memory care area of the facility and made it to the lobby area pass the egress doors. Let it be noted, the lobby area is part of the assisted living area of the facility. LPA reviewed R1’s file and it is documented that R1 has dementia and is housed in the memory care area of the facility. During LPA’s interview with R1, R1 denied leaving the memory care area but did state "they will not be staying at any facility and will try to leave and go home.” LPA interviewed three (3) staff that confirmed R1 has left the memory care area and made it to the lobby area. Staff #1 (S1) confirmed that R1 was informed by another staff that R1 was in the lobby are and needed to go back to the memory care area of the facility. Staff #2 (S2) confirmed that R1 has left the memory care area on multiple occasions and has been seen walking in the assisted living area of the facility. Staff #3 (S3) confirmed that they have seen R1 by their office which is outside of the memory care living area and located in the assisted living area of the facility. After LPA reviewed R1’s file it was determined that R1 was not given adequate supervision and did not have an updated appraisal. LPA attempted to interview six (6) residents in the memory care area, but they were not able to respond to LPA’s interview. Therefore, based on the LPA's record review, staff and resident interviews, the above allegation(s) above is SUBSTANTIATED at this time.

This report supersedes the previous report issued on 03/17/2025 to dismiss and change citations. An appeal was granted.

Licensing Program Analyst (LPA) Gina Saucedo visited the facility to issue an amendment to the Licensing Report previously issued on 03/17/2025. The LPA met with Administrator and explained that the report was amended to correct the type of citation issued during the visit conducted on 03/17/2025. Citation CCR-87705(6)(A) is dismissed and Citation CCR-87411 (d)(3) is being changed to CCR-87468.2(a)(4).

An exit interview was conducted, citation(s) were issued, appeal rights was given and a copy of this report was given to the Administrator.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250312143535
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: NORTHRIDGE VALLEY SENIOR LIVING
FACILITY NUMBER: 197610025
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
03/31/2025
Section Cited
CCR
87705(6)(A)
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Appeal was granted and deficiency was dismissed.
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Deficiency Dismissed
Type B
01/20/2026
Section Cited
CCR
87468(a)(4)
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(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(4)To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications...This requirement is not met by:
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A training record of staff about personal rights of residents is to be sent to CCLD/LPA.
Training of staff was provided to LPA at time of visit.

POC Due Date and Cleard on:01/20/26
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Based on the LPA observation, record reviews and interviews the licensee/administrator did not ensure proper supervision training for staff from the above facility which poses a potential Health, Safety or Personal Rights risks to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
LIC9099 (FAS) - (06/04)
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