197609496-4-1-2026-31-AS-NMAN-DTZ537-20260511193529

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609496
Report Date: 04/01/2026
Date Signed: 04/01/2026 04:14:01 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
03/23/2026 and conducted by Evaluator Tihesha Smith

COMPLAINT CONTROL NUMBER: 31-AS-20260323103456

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: 72	DATE:	04/01/2026
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Rose Yousefian		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Unlawful eviciton
Insufficient staffing to meet the needs of incontinant residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tihesha Smith made an unannounced subsequent complaint visit to this facility to deliver findings. LPA met with staff and disclosed the reason for the visit.

Unlawful eviction
In regard to the above allegation, this allegation is the same allegations to previous complaint number: 31-AS-20250902094715 which has already been investigated and substantiated.

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.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 04/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2026

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-20260323103456

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: 04/01/2026

NARRATIVE

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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. 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. Additional interview conducted today with executive director reveal no new evictions for R1 exist for year 2026. Additional interview with R1 states has not received a new eviction for this year but didn’t remember receiving the results of the investigation.

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.

Insufficient staffing to meet the needs of incontinent residents

In regard to the above allegation this allegation is the same or similar allegation to previous complaint number: 31-AS-20250806114836 which has already been investigated and substantiated.

To investigate the allegation: LPA Smith conducted interviews with staff and R1 from approximately 11:10 am 12:00 pm. Interview conducted with executive director revealed she is still having issues finding and retaining competent caregivers as the hired staff will either quit within the same day or a week starting the position and some of the applicants do not continue with the hiring process. Although hiring process is still on going, observation by licensing staff on previous visits to the facility has observed staff shortage.

Based on interviews and observation there is enough information to verify the allegation. Therefore, the allegation is deemed SUBSTANTIATED at this time

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 04/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2026

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20260323103456

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: 04/01/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/10/2026 Section Cited CCR 87224(a)	1 2 3 4 5 6 7	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:	1 2 3 4 5 6 7	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: 04/10/26
	8 9 10 11 12 13 14	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.	8 9 10 11 12 13 14
Type B 04/10/2026 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	Personnel Requirements - General: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.	1 2 3 4 5 6 7	Licensee will ensure additional staff is hired if required. The staff schedule and written information must be provided explaining the steps taken by the Administrator. POC:04/10/26
	8 9 10 11 12 13 14	This requirement has not been met based on Interviews and executive director admission hiring more staff which poses health and safety risk to the residents in care	8 9 10 11 12 13 14

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: 04/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2026

LIC9099 (FAS) - (06/04)

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