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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608838
Report Date: 12/11/2021
Date Signed: 12/13/2021 07:14:32 AM

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:VILLAGE AT NORTHRIDGE, THEFACILITY NUMBER:
197608838
ADMINISTRATOR:BRADLEE ANN FOERSCHNERFACILITY TYPE:
740
ADDRESS:9222 CORBIN AVETELEPHONE:
(818) 350-2951
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:125CENSUS: 91DATE:
12/11/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Tristan Garcia - Zest DirectorTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced case management visit to this facility to tour the facility and interview staff and residents. LPA met with Zest Director Tristan Garcia and explained the reason for the visit. Mr. Garcia called the Executive Director and informed her of the visit.

During the course of entrance interview, LPA was informed that the facility has a NORO virus outbreak. LPA interview with Zest Director Tristan Garcia revealed that three (3) residents are currently in the hospital due to outbreak and six (6) residents are currently on isolation on their own apartments. LPA phone interview with Executive Director Badlee Foerschner revealed that, she had reported the outbreak to Los Angeles County Department of Public Health (LACDPH) and currently working with Public Health Nurse to contain the outbreak. LPA observation during physical plant tour also revealed that those residents on isolation has PPE set up outside of the room and proper signage posted on the door.

LPA conducted physical plant tour at 11:00 AM and visited random Assisted Living residents' apartments, conducted interview with staff between 11:00 AM to 3:30 PM and requested facility documents at 10:30 AM.

During the physical plant tour, LPA visited seven (7) residents' apartments and observed that the apartments are generally neat, clean and in proper order. LPA interview with nine (9) random residents also revealed that they all feel safe and satisfied with the facility and the staff are respectful and provide sufficient care. LPA also conducted interview with random staff of the facility and all staff expressed no concern about the living condition at the facility.

LPA did not observe any health and safety hazard during this visit.

Exit interview conducted. Copy of this report issued.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary TanTELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2021
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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