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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610191
Report Date: 03/24/2023
Date Signed: 03/24/2023 12:49:33 PM

Document Has Been Signed on 03/24/2023 12:49 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
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: 74DATE:
03/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Cynthia LaraTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted a case management visit, in-conjunction with complaint control # 31-AS-20230321145444. Prior to the visit, LPA had knowledge that the Administrator and Business Office personnel had resigned and there was no replacement at this time. LPA also was made aware, the Regional Director Cassandra Bradford had been overseeing the facility this past week, but was not at the facility during today visit. LPA spoke to her, and LPA will follow up later on today.

At 1045am, the Wellness Director Cynthia Lara arrived and spoke to LPA, who reported that the Regional Director, Memory Care Director, and herself are overseeing the facility until a new Administrator has been hired. LPA informed Wellness Director that a LIC308, designee responsibility needs to be submitted to Licensing.

LPA will also follow up with the Regional Director regarding the issues and concerns for the complaint during today's visit.

Exit interview and copy of report provided.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2023
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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