197609496-8-19-2025-31-AS-NMAN-DKXNQA-20250827103936

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609496
Report Date: 08/19/2025
Date Signed: 08/19/2025 11:44:33 AM

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
04/14/2025 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20250414131655

FACILITY NAME:	ENCINO TERRACE SENIOR LIVING		FACILITY NUMBER:	197609496
ADMINISTRATOR:	JANNAT, SHAHRZAD		FACILITY TYPE:	740
ADDRESS:	16025 VENTURA BLVD		TELEPHONE:	(818) 986-8466
CITY:	ENCINO	STATE: CA	ZIP CODE:	91436
CAPACITY:	85	CENSUS: 52	DATE:	08/19/2025
		UNANNOUNCED	TIME BEGAN:	09:32 AM
MET WITH:	Rose Yousefian, Executive Director		TIME COMPLETED:	11:01 AM

ALLEGATION(S):

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Facility has no activities director.
Facility does not have an administrator.
Licensee has not conducted emergecy drills.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Leslie Ngo Castaneda conducted unannounced subsequent complaint visit to the facility. LPA met Rose Yousefian who is the executive director and explained the purpose of this visit.

The investigation was initiated on 04/23/2025 at which time at 10:15 AM, LPA conducted a physical plant tour. At 10:30 AM LPA requested facility documents relevant to the investigation which include but not limited to staff roster, resident roster, physician report, admission agreement, and other relevant document. LPA interviewed twelve (12) residents out of fifty-eight (58) and eight (8) staff between 10:53 AM to 2:50 PM. LPA reviewed records of staff between 2:50PM to 3:30 PM.

Prior to this visit LPA Ngo Castaneda reviewed additional records previously gathered at the facility.

Continue to LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025

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-20250414131655

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: ENCINO TERRACE SENIOR LIVING	FACILITY NUMBER: 197609496
	VISIT DATE: 08/19/2025

NARRATIVE

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Allegation#1: Facility has no activities director.

It was alleged that the facility has no activities director.

Interviews with the facility staff including executive director (S1), business director (S2), and activities director (S3) and other facility staff revealed that the current activities director has held the position since November 2024. A review of staff roster and personnel files for the last few months and of the staff list confirmed S3 has been the activity director. Interview with S3 at 2:20 PM on 4.23.2025 confirmed they are and have been the activity director. Residents interviewed during investigation also verified that the facility has activity director. A review of S3’s personnel record verified the information revealed from interviews.

Based on observation, interviews and record review, the facility has an activity director. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Allegation #2: Facility does not have an administrator.

It was alleged that the facility administrator was fired and no facility representatives from management were available to report to. During investigation LPA observed Executive Director (ED) (S1) and other administrative personnel present and available in the facility. Interview with S1 and S2 at 2:47 PM on 04/23/25 revealed that they were hired 3 days ago. Prior to hiring of new ED, Business Office manager (S2) was acting Executive Director and has been in charge of the facility. Interviews with Resident Service Coordinator (S8) and other facility personnel revealed that in the absence of ED, there are always someone designated to act as an Administrator. All staff including administrative personnel were trained to report any concerns and incidents to S2 or other designee. Interviews with eleven (11) out of fifty-eight (58) residents revealed that management is always seen at the facility assisting staff and residents as needed.

A review of staff roster and personnel records verified the information revealed from interviews. Based on observation, interviews and record review, although the ED is not always present at the facility, the facility ensured that a qualified designee is always present and available to manage facility staff and assist families and residents as needed. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Continue to LIC 9099-C

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250414131655

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: ENCINO TERRACE SENIOR LIVING	FACILITY NUMBER: 197609496
	VISIT DATE: 08/19/2025

NARRATIVE

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Allegation #3: Licensee has not conducted emergency drills.

It was alleged that the facility has not conducted an emergency drill ever. ED and other managers indicated they have a contract with the Southwest Fire Life Safety and Security and just conducted the emergency fire drill on 04/23/25 in the morning. Staff stated there are always one to two full-time staff members who will work with the agency staff in the overnight shift. When they have any fire or disaster drills, the facility staff on the shift and temporary agency staff present in the facility are participating during the drill. In the event of any emergency, staff know where to obtain the emergency contact numbers and LIC610E Emergency Disaster Plan. During facility inspection LPA observed the emergency disaster plan posted and a Fire and Disaster Guidelines binder by the S2 office. Residents interviewed during investigation did not address any concerns regarding emergency disaster drill. Residents feel that there are sufficient well trained staff to assist residents during emergencies. A review of the facility records verified that facility is conducting quarterly emergency drills as required. Based on observation, interviews, and record review, there is no sufficient information to verify validity of the complaint. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazard is noted during this visit.

Exit Interview conducted. Copy of report provided to ED.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025

LIC9099 (FAS) - (06/04)

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