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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610025
Report Date: 08/12/2025
Date Signed: 08/12/2025 01:26:17 PM

Document Has Been Signed on 08/12/2025 01:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 LIVINGFACILITY NUMBER:
197610025
ADMINISTRATOR/
DIRECTOR:		KAREN MARINFACILITY TYPE:
740
ADDRESS:8700 LINDLEY AVENUETELEPHONE:
(818) 886-5181
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 110CENSUS: 73DATE:
08/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH:Frances Norberte, Memory Care DirectorTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 08/12/25 at 8:10AM, Licensing Program Analyst (LPA) Gina Saucedo arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with Frances Norberte, Memory Care Director and disclosed the purpose of the visit.

LPA asked for the census, resident, and staff rosters and files. A physical tour was conducted at 10:05AM and observed the following:

The entire facility has a total of 110 (one-hundred and ten) beds. Forty-three (43) are currently in the memory care unit and 44 (forty-four) in the Assisted Living area being occupied. All the rooms are on the second floor. The floor is divided by assisted living and memory care. The assisted living is on your left-hand side of the facility and the memory care is on your right-hand side of the facility. The second floor consists of a medication room which is in the memory care section. The memory care section has their own activity, dining hall, two (2) enclosed patio and enclosed gardens. There is also four (4) delayed egress on the doors in memory care. The assisted living side has their own activity room upstairs and another room downstairs. The assisted living side has access to the ground level which is the first floor which has the laundry room area, beauty salon, dining hall, kitchen access to the patio area, another activity room area and a staff lounge. The parking structure can be entered from this area and from the street area.


LIC 809C-continued
NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 08/12/2025
NARRATIVE
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Random Bedrooms and Bathrooms were randomly selected to tour and were observed to have appropriate furniture, lightening, bedding, and televisions. Random Bathrooms were observed to have grab bars and non-skid mats. Hot water temperature was tested randomly for and measured 113-114-degree Fahrenheit. The random bedrooms and bathrooms had pull-cord alarms. The public bathrooms in the assisted living area had emergency pull-cord alarms.

Fire extinguishers were observed throughout the facility and were fully charged on green with the same expiration dates- August 2025. There are fire extinguishers upstairs, downstairs, in the kitchen area and parking lot structure. Carbon Monoxide and fire sprinklers are located throughout the facility and are operable.

Facility has a designated medication room that is inaccessible to residents where all the medication is stored and locked in the memory care side of the facility. The medication was revised randomly.

The assisted living area: outside/backyard is accessible to residents with different areas for them to sit. There is appropriate outdoor furniture for the residents to sit on with proper shading. There is no bodies of water.

Common Areas: These include the dining areas, beauty salon, and activities room. All common areas were observed to be cleaned and properly furnished. The activity room has a large television and has enough seating for several residents to watch the television and do different activities. Facility maintains a comfortable temperature of in between 74 and 77-degree Fahrenheit. There are several temperature thermostats throughout the facility. There are several common bathrooms throughout the upstairs and downstairs area. The staff and resident bathrooms are not shared. There are trash cans with lids and covid signs posted in the common bathrooms. There is toilet paper and napkins. The exit stairways leading to the downstairs area all have evacuation chairs. There are several hand sanitizers against the wall throughout the facility.


LIC 809C-continued
NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 08/12/2025
NARRATIVE
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The Kitchen area was toured and observed there to be sufficient seven (7) day supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. The chemicals are inaccessible to the residents which can be accessed via the kitchen area in a locked door. Against the wall of the kitchen towards the back is a Resident's Diet Plan Board.

Administrative: The Insurance plan is current and dated 10/2025. There is a disaster plan, licensee certificate, YES sign, Resident Rights, and Rights of Resident Council against the wall facing the entrance of the facility on your right hand side. The Ombudsman sign is on your left hand side of the entrance of the facility. The last fire drill/emergency drill was conducted in July of 2025.

An exit interview was conducted, citation(s) were issued, appeals rights, and a copy of this report was given to the memory care director.

Citations were issued on Plan of Correction of Elopement of resident on 03/17/25 which was due on 03/31/25 and was never sent to Community Care Licensing/LPA and the garage area has hazardous materials such as bed mattresses and sofas next to parking spaces that need to be disposed of or stored in a storage area.

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/12/2025 01:26 PM - It Cannot Be Edited


Created By: Gina Saucedo On 08/12/2025 at 11:36 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 08/12/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(a)
Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above in one (1) out of one (1) area of the garage where there are several mattresses and a sofa in the parking space area which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/29/2025
Plan of Correction
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The mattresses and sofa are to be removed from the garage area/parking spaces and be placed in a storage area and/or disposed of.
Type B
Section Cited
CCR
87705(e)(6)(A)
Care of Persons with Dementia
(e) Licensees that use delayed egress devices on exterior doors and perimeter fence gates shall meet the following initial and continuing requirements: (6) For each incident of elopement, as defined in Section 87101, Definitions, the licensee shall report the incident to: (A) The resident's representative, if applicable, immediately upon becoming aware of the incident. A written report shall also be provided to the resident’s representative as specified in Section 87211, Reporting Requirements. Documentation of the report shall be added to the resident’s record.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in one (1) out of (1) resident that had eloped from the egress doors from memory care was not reported to the family and/or entered in the resident's file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/29/2025
Plan of Correction
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The above facility/administrator/licensee shall advise the family member about the incident regarding resident's elopement from memory care into the assisted living area of the facility and enter it in their file.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Troy Agard
NAME OF LICENSING PROGRAM MANAGER:
Gina Saucedo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/12/2025 01:26 PM - It Cannot Be Edited


Created By: Gina Saucedo On 08/12/2025 at 11:36 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 08/12/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87705(e)(6)(B)
Care of Persons with Dementia
(e) Licensees that use delayed egress devices on exterior doors and perimeter fence gates shall meet the following initial and continuing requirements: (6) For each incident of elopement, as defined in Section 87101, Definitions, the licensee shall report the incident to: (B) The licensing agency Officer of the Day, by telephone, e-mail, fax, or hand-delivery no later than the next working day following the incident. If reported by telephone, a written report shall also be submitted to the licensing agency as specified in Section 87211, Reporting Requirements. The report shall be added to the resident's record.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in one (1) out of (1) resident that had eloped from the egress doors from memory care was not reported to Community Care Licensing Department and/or LPA which poses/posed a potential health, safety or personal rights risk to persons in care..
POC Due Date: 08/29/2025
Plan of Correction
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The above facility/administrator/licensee shall send the Unusual Incident Report regarding the resident and their elopement via the egress doors.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Troy Agard
NAME OF LICENSING PROGRAM MANAGER:
Gina Saucedo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2025


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