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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609022
Report Date: 02/17/2026
Date Signed: 02/17/2026 04:33:07 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
12/22/2025 and conducted by Evaluator Nadia Shahbazian
COMPLAINT CONTROL NUMBER: 31-AS-20251222162029
FACILITY NAME:EVERGREEN RETIREMENTFACILITY NUMBER:
197609022
ADMINISTRATOR:TANYA QUEZADAFACILITY TYPE:
740
ADDRESS:225 NORTH EVERGREEN STREETTELEPHONE:
(818) 843-8268
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY:99CENSUS: 77DATE:
02/17/2026
UNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Tanya Quezada - Executive DirectorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not prevent facility from being in disrepair.
Staff are not providing adequate food service to residents in care.
INVESTIGATION FINDINGS:
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On 02/17/2026 Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced subsequent complaint investigation visit to the facility regarding above allegations. LPA met with Tanya Quezada-Executive Director/Administrator and explained purpose of the visit.
On 02/17/2026 LPA Shahbazian requested copies of the Staff Roster, Resident Roster, facility menus and documents regarding Resident 1 (R1). During today’s visit, LPA interviewed residents and staff and conducted a tour of the facility, including kitchen; no immediate health and safety issues were observed.

Regarding the allegation: Staff did not prevent facility from being in disrepair. It is being alleged that for last few months the kitchen was shut down during weekends due to the plumbing issues. LPA interviewed eight (8) residents. Interview with two (2) out of eight (8) residents revealed that they remember the kitchen being closed due to repairs for short time but did not remember exact date, additionally they stated facility notified residents of the repairs. Six (6) out of the eight (8) residents stated that they don't remember closure of the kitchen, or were not concerned, since food was always provided to them.
Continue on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2026
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 2
Control Number 31-AS-20251222162029
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: EVERGREEN RETIREMENT
FACILITY NUMBER: 197609022
VISIT DATE: 02/17/2026
NARRATIVE
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LPA interviewed Administrator who stated that back in March 2025, a pipe leading from a small part of the kitchen to the street had burst. Administrator provided a copy of a service contract from a contractor to LPA regarding work to be done, including replacing pipes and concrete. Administrator stated repairs were completed within a few days and residents were notified that food will be ordered from a catering company. Residents were not affected since meals were ordered and served in the dining room or residents' rooms. Based on interviews with staff and residents it was revealed that facility notified residents of the kitchen repair efforts and residents stated they were not affected, therefore above is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff are not providing adequate food service to residents in care. It is being alleged that the food portions are small, and that staff are not meeting R1’s dietary needs. LPA interviewed eight (8) residents. Two (2) out of eight (8) residents revealed that food portions are sometimes small but they can ask for more. Only one (1) out of eight (8) residents stated that their dietary needs are not always provided. Six (6) out of the eight (8) residents stated that food choices are sufficient and there is always fruit, vegetables and alternative choices available daily. Interview with staff revealed that menu is prepared a month in advance and is posted weekly in common areas and in the facility’s newsletter. Staff stated that food quality and portions are good and balanced. Facility provides three meals, which includes vegetables, fruits, salad and dessert with a secondary menu for residents who do not like the meal of the day, as additional options. Residents may ask for more food, which is provided throughout the night. Residents can notify the caregivers or dining room staff of their food preferences, if they don't like the food of the day and the kitchen staff will prepare a different meal for them. During the visit to the kitchen, LPA observed a roster of residents with dietary needs, including R1, for whom meals are prepared based on physician's provided instructions. LPA observed sufficient supply of perishable (2 days) and non-perishable (7 days) food items in the pantries, refrigerators and freezers. LPA obtained copy of menus from September 2025 through December 2025, in which a diet for residents with meat or vegetable preference can be observed. Based on interviews with staff and residents, it was revealed that facility provides adequate meal sizes and choices, therefore the above allegation is UNSUBSTANTIATED at this time.

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2