197609496-12-4-2025-31-AS-NMAN-DT4VKR-20260413163042

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609496
Report Date: 12/04/2025
Date Signed: 12/04/2025 04:49:35 PM

Unsubstantiated

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
08/04/2025 and conducted by Evaluator Tihesha Smith

COMPLAINT CONTROL NUMBER: 31-AS-20250804081258

FACILITY NAME:	ENCINO TERRACE SENIOR LIVING		FACILITY NUMBER:	197609496
ADMINISTRATOR:	ROSE YOUSEFIAN		FACILITY TYPE:	740
ADDRESS:	16025 VENTURA BLVD		TELEPHONE:	(818) 986-8466
CITY:	ENCINO	STATE: CA	ZIP CODE:	91436
CAPACITY:	85	CENSUS: 60	DATE:	12/04/2025
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Rose Yousefian		TIME COMPLETED:	04:55 PM

ALLEGATION(S):

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Staff do not ensure residents are accorded right to choose their own health care providers
Staff did not ensure resident was admitted with complete medical records upon entry to the facility

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Tihesha Smith made a subsequent unannounced complaint visit to the facility,met with the administrator and disclosed the purpose of the visit.
During initial visit, on 08/13/2025, LPA Smith requested documents relevant to the investigation to include but not limited to a copy of admissions agreement, Personnel Report, Staff schedule, Resident roster. LPA Smith conducted interviews with the administrator and three (3) residents from approximately 11:10 am -1:10 pm.
Regarding Allegation: Staff do not ensure residents are accorded right to choose their own health care providers.
Interview with the administrator revealed that the facility contracts with physicians and informs residents and/or their representatives of the option to use these providers during admission. In R1’s case, contracted physician services were offered due to concerns about the lack of consistent medical updates from R1’s private doctor. The administrator stated that R1 was not pressured or required to use the facility’s physicians

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250804081258

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: 12/04/2025

NARRATIVE

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Review of R1’s physician report confirmed care by a private doctor, but the documentation was outdated.

Interviews with five (5) of six (6) residents revealed they had a choice in choosing their own provider and were not forced to choose the facility doctor. R1 revealed that they didn’t have the right to choose their own healthcare provider but when LPA Smith asked when they started receiving medical care from the facility doctor R1 revealed they have their own doctor and didn’t choose to sign up to use the facility doctor.

Based on the information obtained, there is not enough information to verify the allegation, therefore the allegation is UNSUBSTANTIATED at this time.

Staff did not ensure residents were admitted with complete medical records upon entry to the facility

In regard to the allegation, it was alleged that staff did not ensure residents were admitted with complete medical records upon entry to the facility specifically without their medication. Interview with administrator revealed that complete medical records are not a requirement for entry into the facility as in California residential care facilities for the elderly (RCFE) are non-medical facilities, so the admission does not require a complete medical record. Administrator also revealed that each resident does need a physician’s report completed and signed by a licensed physician with in 12 months prior to admission, preappraisal, current TB test or risk assessment, and appraisal/needs and services plan. Administrator states that medication is either brought with the resident or they may have to coordinate with residents’ private pharmacy or new admission will elect to use facility medication program. LPA reviewed Resident #4 (R4) records to include admissions agreement, physician’s report, controlled medication record. R4 elected to use facility medication program and medications dispensed to R4 has been logged since 7/13/2025.

Based on the information obtained, there is not enough information to verify the allegation, therefore the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted copy of report given

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025

LIC9099 (FAS) - (06/04)

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