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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610191
Report Date: 07/29/2025
Date Signed: 07/29/2025 02:42:10 PM

Document Has Been Signed on 07/29/2025 02:42 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:GARDENS AT NORTHRIDGE, THEFACILITY NUMBER:
197610191
ADMINISTRATOR/
DIRECTOR:		LISA VILLASENORFACILITY TYPE:
741
ADDRESS:17650 WEST DEVONSHIRE STREETTELEPHONE:
(818) 886-1616
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 135CENSUS: 99DATE:
07/29/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH:Lisa Villasenor, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On 07/29/25 at 8:10 AM, Licensing Program Analyst (LPA) Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. LPA Saucedo met with Executive Director, Lisa Villasenor and Cinthia Lara Vargas-Resident Service Director and disclosed the purpose of the visit.

LPA asked for the census, resident, and staff files.


At 9:45 AM a physical tour was conducted for both the Assisted Living Area and Memory Care Area:



The entire facility has a total of 135 (one-hundred and thirty-five) beds. The facility is a two-story building: First floor and second floor: It is both assisted living and memory care. The facility has one (1) memory care units which is located on the back section of the facility and the assisted living is in the front section and upstairs. The memory care area can hold up to twenty-four (24) rooms and the Assisted Living area can hold up to 115 (one-hundred fifteen) rooms. The memory care door has a code and delayed egress on the doors. The Memory Care area of the facility has its own laundry room, living room/activity area, dining hall area, enclosed patio area, a common shower room that any resident can use and a medication room. All hand sanitizers and fire extinguishers in this area are covered so residents cannot have access to them only visitors and/or staff. The assisted living side has their own activity room, salon, library, dining hall, two (2) patio areas with proper seating for residents and two (2) laundry areas one (1) upstairs and one (1) downstairs. Besides the large industrial washers and dryers that residents cannot use, there are two (2) other laundry rooms that can be used by residents. There are also two (2) elevators 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: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2025
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.

LIC809 (FAS) - (09/23)
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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: GARDENS AT NORTHRIDGE, THE
FACILITY NUMBER: 197610191
VISIT DATE: 07/29/2025
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Random Bedrooms were randomly selected to tour and were observed to have appropriate furniture, proper lights, bedding, televisions, closets and pull cord alarms.

Random Bathrooms were observed to have grab bars and non-skid mats. Hot water temperature was tested randomly for and measured 118–120-degree Fahrenheit.

There are two (2) medication rooms one (1) on the first floor and one (1) on the second floor. The medication is locked and inaccessible to the residents. They are also medication carts in the Wellness centers.

Fire extinguishers were observed throughout the facility and were fully charged on green with different dates such as September and October 2025. There are fire extinguishers upstairs, downstairs and in the kitchen area. Carbon Monoxide and fire sprinklers are located throughout the facility.

Common Areas: These include the dining areas, activities room, television rooms: All common areas were observed to be cleaned and properly furnished. Facility maintains a comfortable temperature of 74.-79-degree Fahrenheit. There are several temperature thermostats throughout the facility. There are several common bathrooms throughout the upstairs and downstairs area. There are trash cans with lids and covid signs posted in the common bathrooms. There is toilet paper and napkins. There are also pull cords in these bathrooms. The facility has no bodies of water. There is a water fountain next to the memory care area. The mailbox for residents is also located in this area. There is also a salon and spa room in this area of the facility. Next to the salon and spa room is the Activities Room. There is also a library area in this section of the facility leading to the memory care. There is a bathroom with a large shower area upstairs that can be used for wheelchair accessible residents. The exit stairways upstairs all have evacuation chairs. There are several hand sanitizers against the wall throughout the facility. There is a theater upstairs.

There are two (2) laundry rooms for resident use in the assisted area of the facility. There is one (1) downstairs on your left hand side of the entrance of the facility and there is another one (1) upstairs on your left hand side.

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

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: GARDENS AT NORTHRIDGE, THE
FACILITY NUMBER: 197610191
VISIT DATE: 07/29/2025
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The Kitchen area was toured, and LPA observed sufficient supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. The kitchen is located on the first floor. The assisted dining area has access to this kitchen where at the time of the tour different residents were having breakfast with proper feeding utensils/plates/cups. The kitchen area has a first aid kit and CPR-Cardiopulmonary resuscitation kit against the wall. Against the wall of the kitchen on your right-hand side is a Resident's Diet Board.

Administrative: The Insurance plan is updated- 10/2025. There is an Emergency Disaster plan, House Rules, Rights of Resident Council, YES sign, Resident Rights, Facility Sketch, Ombudsman and Theft and Loss Policy against the wall on your left-hand side of the facility near the entrance of the memory care. The last fire drill/evacuation drill/Theft and Loss was conducted in June 2025. In August there is a new company that has being hired to do drills named Southwest Fire.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the executive director.

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

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
LIC809 (FAS) - (06/04)
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