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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610191
Report Date: 02/24/2025
Date Signed: 02/24/2025 02:58:10 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
02/19/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250219151035
FACILITY NAME:GARDENS AT NORTHRIDGE, THEFACILITY NUMBER:
197610191
ADMINISTRATOR:LISA VILLASENORFACILITY TYPE:
741
ADDRESS:17650 WEST DEVONSHIRE STREETTELEPHONE:
(818) 886-1616
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:135CENSUS: 98DATE:
02/24/2025
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Lisa Villasenor, Exexutive DirectorTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Licensee did not provide adequate notice of fee increase to resident’s representative.
Licensee did not ensure facility was maintained in good repair.
Staff did not ensure hazardous equipment was inaccessible to resident.
INVESTIGATION FINDINGS:
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On 02/24/25, at 9:25am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Executive Director, Lisa Villasenor. LPA explained the purpose of this visit was to gather information, interview staff and residents and deliver findings for this complaint.

On 02/24/25, LPA Saucedo asked for the census, staff, and resident rosters. On 02/24/25, 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: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
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 5
Control Number 31-AS-20250219151035
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: GARDENS AT NORTHRIDGE, THE
FACILITY NUMBER: 197610191
VISIT DATE: 02/24/2025
NARRATIVE
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Regarding the allegation: Licensee did not provide adequate notice of fee increase to resident’s representative. It is being alleged that the representative did not get notice of the rent increase. LPA spoke to resident #1 (R1) who resides in the Assisted Living Area of the facility and asked if they received a sixty (60) day notice for rent increase. Let it be noted, R1 is self-Independent, ambulatory and alert. In addition, the R1's representative changed their address and did not notify the facility. R1 stated they do not always check their mailbox but maybe they did receive it. LPA spoke to staff #1 (S1) who confirmed R1 received a sixty (60) day notice for the rent increase. LPA obtained a copy of the sixty (60) that was issued to R1 on April 29, 2024 to be effective August 01, 2024. Based on the LPA's observations and record reviews, staff and resident interviews conducted the allegation is UNSUBSTANTIATED at this time.

Regarding the allegation: Licensee did not ensure facility was maintained in good repair. It is being alleged that three or four months ago there was an issue with the lock on the door to resident #1 (R1)’s room and the door frame broke. LPA interviewed resident #`1 (R1) who confirmed that when their door lock broke it was repaired right away along with the door frame. R1 stated I have not had any issues coming in and out of that room. LPA spoke to Staff #`1(S1) that confirmed R1's door was repaired right away and R1 was given the option to move rooms when it was being repaired but refused to move out of that room. S1 also stated, R1 has not had issues coming in and out of their room. LPA also interviewed Staff #2 (S2) who confirmed R1's door was repaired as soon as they got the work order for repair and R1 has not complained since the repair was completed. During LPA's physical tour, LPA took a picture of R1's door and was able to observe R1 go in and out of their room without any issues. Based on the LPA's observations, staff and resident interviews conducted the allegation is UNSUBSTANTIATED at this time.



Regarding the allegation: Staff did not ensure hazardous equipment was inaccessible to resident. It is being alleged that resident #1 (R1)’s central air conditioning and heating has not worked for at least one (1) year so staff placed a space heater and window Air Conditioner (AC) unit in the room which is hazardous to R1. Let it be noted that R1 is in the assisted living area of the facility, alert and Independent. LPA interviewed R1 who agreed that they want to continue having their space heater and window Air Conditioner in their room because they can change the temperatures when they want but they cannot manage the central air conditioning provided by the facility. R1 stated I want to keep both air conditioner and space heater that was provided to me. LPA spoke to Staff #1 (S1) that confirmed R1 does not want to return the space heater or have the air conditioner on the window removed from their room. Based on the LPA's observations and record reviews, staff and resident interviews conducted the allegation is UNSUBSTANTIATED at this time.

An exit interview was conducted and a copy of this report was given to the Executive Director.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
02/19/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250219151035

FACILITY NAME:GARDENS AT NORTHRIDGE, THEFACILITY NUMBER:
197610191
ADMINISTRATOR:LISA VILLASENORFACILITY TYPE:
741
ADDRESS:17650 WEST DEVONSHIRE STREETTELEPHONE:
(818) 886-1616
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:135CENSUS: 98DATE:
02/24/2025
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Lisa Villasenor, Exexutive DirectorTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Licensee charged resident for services not received.
Licensee did not provide resident’s representative with an itemized statement of charges.
INVESTIGATION FINDINGS:
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On 02/24/25, at 9:25am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Executive Director, Lisa Villasenor. LPA explained the purpose of this visit was to gather information, interview staff and residents and deliver findings for this complaint.

On 02/24/25, LPA Saucedo asked for the census, staff, and resident rosters. On 02/24/25, 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: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
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 5
Control Number 31-AS-20250219151035
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: GARDENS AT NORTHRIDGE, THE
FACILITY NUMBER: 197610191
VISIT DATE: 02/24/2025
NARRATIVE
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Regarding the allegation: Licensee charged resident for services not received. It is being alleged that resident #1 (R1) was charged for services they did not receive. R1 moved into the facility in October of 2022 and was documented as being Independent for services meaning R1 did not need help with any type of extra services. In addition, R1 is documented as ambulatory and self-independent on his Identification. LPA interviewed staff # 1 (S1) and Staff # 3 (S3) and both confirmed R1 was Independent and did not need any type of extra services. LPA reviewed R1's file and R1 was shown as being Independent not needing any type of services but there were charges of $500.00 under level one care for seventeen (17) months. LPA interviewed R1 and R1 confirmed that they have recently received medication management but was not receiving these services before. The above facility had R1 labeled as receiving level one care since November of 2022 but the level one care plan's effective date was not supposed to take effect until 06/2024 when R1 starting receiving level one care. Based on the LPA's observations, staff and resident interviews conducted the allegation is SUBSTANTIATED at this time.

Regarding the allegation: Licensee did not provide resident’s representative with an itemized statement of charges. It is being alleged that due to all the billing discrepancies, the itemized statement of all of the charges were wrongly documented. LPA interviewed staff #1 (S1) and staff #3 (S3) and both confirmed that Resident #1 (R1)'s itemized statement was not correctly documented. LPA obtained and reviewed the documentation that shows the itemized statement of charges being provided to R1 and resulted in discrepancies. The discrepancy amount is $5250.00 that needs to be reimbursed. Based on the LPA's observations and record reviews, staff interviews conducted the allegation is SUBSTANTIATED at this time.

An exit interview was conducted, citation(s) were issued, appeals right was provided and a copy of this report was given to the Executive Director.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20250219151035
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: GARDENS AT NORTHRIDGE, THE
FACILITY NUMBER: 197610191
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/10/2025
Section Cited
CCR
87507(g)(3)(C)
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87507 Admission Agreements
(g) Admission agreements shall specify the following:(3)Payment provisions, including the following: (C) Any fee that is charged prior to or after admission, shall be clearly specified...
This requirement was not met by:
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The Licensee/Administrator shall reimburse/provide credit to the resident/resident's representative for the services that were being charged but not received in the amount of $5250.00
POC Due Date:03/10/25.
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Based on the observations, interviews and
record reviews, the licensee/administrator did
not ensure a resident being charged for services at the above facility that were not being provided which poses potential Health, Safety or Personal Rights risks to person in care
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Type B
03/10/2025
Section Cited
CCR
87507(g)(3)(A)
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87507Admission Agreements(g)..shall specify the following:(3) Payment provisions, including the following: (A) Rate for all basic services which the facility is required to provide..Basic services rate(s), including: 1.A comprehensive description of any items and services..
This requirement is not met by:
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The Licensee/Administrator shall document all services being provided to the resident properly and itemized in the forthcoming biling statements.

POC Due Date:03/10/25.
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Based on the observations, interviews and
record reviews, the licensee/administrator did
not ensure a resident's billing statement to be corrent which poses potential Health, Safety or Personal Rights risks to person 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: 02/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5