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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609496
Report Date: 09/17/2025
Date Signed: 09/17/2025 02:28:23 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/02/2025 and conducted by Evaluator Tihesha Smith
COMPLAINT CONTROL NUMBER: 31-AS-20250902094715
FACILITY NAME:ENCINO TERRACE SENIOR LIVINGFACILITY NUMBER:
197609496
ADMINISTRATOR:ROSE YOUSEFIANFACILITY TYPE:
740
ADDRESS:16025 VENTURA BLVDTELEPHONE:
(818) 986-8466
CITY:ENCINOSTATE: CAZIP CODE:
91436
CAPACITY:85CENSUS: 57DATE:
09/17/2025
UNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH:Charistie Herrera, Business Ofc ManagerTIME COMPLETED:
02:33 PM
ALLEGATION(S):
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Unlawful Eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tihesha Smith conducted an unannounced complaint visit to this facility to deliver findings. LPA Smith was greeted by staff and disclosed the purpose of the visit.

Allegation: Unlawful Eviction

To investigate this allegation, on 09/11/2025, LPA Smith interviewed staff and requested copies of facility documents relevant to the investigation from approximately 2:35 pm - 3:30 pm. LPA Smith briefly observed facility grounds.

During the course of the investigation the records of R1 were reviewed to include but not limited to admission agreement, physician report, and medication administration record. Record review reveals R1’s last physician report was completed 10/31/23 to 11/22/23 clear of any declining health or behavioral changes noted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
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 3
Control Number 31-AS-20250902094715
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ENCINO TERRACE SENIOR LIVING
FACILITY NUMBER: 197609496
VISIT DATE: 09/17/2025
NARRATIVE
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(Cont from 9099)

There is a notification of incident or change of condition document on 04/16/24 and 04/17/24 regarding aggressive language and behavior disturbance however no assessments for the resident were completed following those incidents.

Two (2) of two (2) staff reveal R1 sending numerous email messages and are not taking their medication. Interviews with the executive director reveal that there are not any current year reappraisals for R1 documenting any changes in behavior, non-compliance with medication including no written warnings or notices to R1 noting any failure to comply with state, local law or any violations of community rules.

Based on record review and interviews there is sufficient evidence to support the allegation of unlawful eviction. Therefore, the allegation is deemed Substantiated at this time.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250902094715
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ENCINO TERRACE SENIOR LIVING
FACILITY NUMBER: 197609496
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/01/2025
Section Cited
CCR
87224(a)
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Eviction Notification (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5).[...]This is evidenced by:
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Administrator will need to provide current reappraisal for R1, review Title 22 regarding Eviction process, provide plan on how to ensure residents that are not enrolled in facility managed care program remain compliant to include medically compliant.
POC: 10/01/25
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 The Administrator failed to have R1 reassessed and failed to provide any warning notices or documentation that R1 is out of medical compliance, has any current behavior changes and/or is not following community rules.
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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: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3