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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610191
Report Date: 02/09/2023
Date Signed: 02/14/2023 12:59:04 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/08/2023 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20230208112018
FACILITY NAME:GARDENS AT NORTHRIDGE, THEFACILITY NUMBER:
197610191
ADMINISTRATOR:GENA GRUNDEISFACILITY TYPE:
741
ADDRESS:17650 WEST DEVONSHIRE STREETTELEPHONE:
(818) 886-1616
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:135CENSUS: 68DATE:
02/09/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Gena Grundies, Executive Director TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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7
8
9
Staff handled resident in rough manner.
Staff forced resident to sign form.
INVESTIGATION FINDINGS:
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2
3
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5
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13
At 9:00am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility in response to the above mentioned allegations. LPA was screened for COVID symptoms before allowing entry to the facility. LPA met with the Executive Director and explained the reason for the visit.

Allegation #1: Staff handled resident in rough manner.

To investigate the allegation, on 02/09/2023 at 09:30am, LPA requested a copy of facility records. At 10:00am, LPA conducted a tour of the facility, made observations and interviewed the Executive Director, staff and residents. Record review (facility resident roster) did not show that the individual in question is a current resident at this facility. Interviews with the Executive Director, four (4) staff members and six (6) residents revealed that the individual in question was never a resident of this facility. In addition, at 11:45am, contact was made with reporting persons and it was confirmed that the individual in question was not a Continue on LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
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 4
Control Number 31-AS-20230208112018
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GARDENS AT NORTHRIDGE, THE
FACILITY NUMBER: 197610191
VISIT DATE: 02/09/2023
NARRATIVE
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a resident of this facility. It was also confirmed that the individual in question was admitted to the skilled nursing facility of "Aspen" which is not a part of Assisted Living nor Memory Care licensed by Department of Social Services / Community Care Licensing. The skilled nursing is located on the same property of The Gardens at Northridge. Finally, LPA interviewed staff at the skilled nursing facility located on the same grounds and confirmed that the resident in question is currently admitted in skilled nursing. Therefore, based on interviews this allegation is deemed Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Allegation #2: Staff forced resident to sign form.

The skilled nursing facility "Aspen" which is not a part of Assisted Living nor Memory Care licensed by Department of Social Services / Community Care Licensing is located on the same property of The Gardens at Northridge. LPA interviewed staff at the skilled nursing facility, located on the same grounds, and confirmed that the individual in question is currently admitted in skilled nursing. Therefore, based on interviews this allegation is deemed Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/08/2023 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20230208112018

FACILITY NAME:GARDENS AT NORTHRIDGE, THEFACILITY NUMBER:
197610191
ADMINISTRATOR:GENA GRUNDEISFACILITY TYPE:
741
ADDRESS:17650 WEST DEVONSHIRE STREETTELEPHONE:
(818) 886-1616
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:135CENSUS: 68DATE:
02/09/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Gena Grundies, Executive Director TIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is short staffed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At 9:00am, Licensing Program Analyst (LPA) Angela Panushkina arrived a the facility in response to the above mentioned allegations. LPA was screened for COVID symptoms before allowing entry to the facility. LPA met with the Executive Director and explained the reason for the visit.

LPA conducted a tour and interviewed the Executive Director, Resident Care Director, two (2) staff members, a MedTech and a sample of six (6) out of eight (8) residents from 9:15am to 12:00pm. During the tour LPA randomly tested resident’s pendant.

Allegation: Facility is short staffed;

Interviews with six (6) out of eight (8) residents, revealed that staff are meeting their needs within a timely manner and they are happy with services. Continue on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20230208112018
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GARDENS AT NORTHRIDGE, THE
FACILITY NUMBER: 197610191
VISIT DATE: 02/09/2023
NARRATIVE
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2
3
4
5
6
7
8
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32
LPA conducted a random inspection of the pendant at 10:29am, staff responded within a reasonable time at 10:31am. The facilities expectation for response time is 15 minutes. Interviews with the Executive Director, Resident Care Director, two (2) staff members and a MedTech revealed that there is sufficient staffing to meet the needs of the resident’s timely due to their communication with each other. Interviews also revealed that the MedTech will step in to assist caregivers as needed. Based on LPAs observation and the information obtained through interviews this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4