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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610025
Report Date: 06/03/2025
Date Signed: 06/03/2025 10:28:13 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
05/16/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250516083811
FACILITY NAME:NORTHRIDGE VALLEY SENIOR LIVINGFACILITY NUMBER:
197610025
ADMINISTRATOR:KAREN MARINFACILITY TYPE:
740
ADDRESS:8700 LINDLEY AVENUETELEPHONE:
(818) 886-5181
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:110CENSUS: 74DATE:
06/03/2025
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:KAREN MARIN, AdministratorTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff caused injury to resident in care
INVESTIGATION FINDINGS:
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On 06/03/25, at 9:25am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Administrator, Karin Marin. LPA explained the purpose of this visit was to gather additional information and deliver findings for this complaint.

On 05/16/25, the above complaint was referred to the Investigations Branch (IB) but was returned to the Regional Office (RO) on 05/19/25 for investigation. On 05/19/25, LPA Saucedo conducted an initial complaint and asked for the census, staff, and resident rosters. On 05/19/25, LPA Saucedo interviewed staff, residents and conducted a physical plant tour.

LIC 9099C-continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
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 2
Control Number 31-AS-20250516083811
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: NORTHRIDGE VALLEY SENIOR LIVING
FACILITY NUMBER: 197610025
VISIT DATE: 06/03/2025
NARRATIVE
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Regarding the allegation: It is being alleged that resident #1 (R1) is being physically abused by staff. LPA interviewed two (2) staff that were present the morning of May 14th 2025. The two (2) staff that were present during the morning shift confirmed that there was blood on R1’s right arm and when they noticed it, R1 had a small skin tear. One (1) of the staff advised one (1) of medical technician staff about R1’s right arm and the medical technician applied first aid and bandaged R1’s arm. LPA received the end of shift summary from the medical technician stating skin care they had provided to R1. LPA also attempted to interview R1. Let it be noted, R1 is diagnosed with Dementia. When LPA asked R1 what happened to their arm, R1 touched their hand and said they had a cut. LPA asked R1 how they got the cut but R1 did not answer LPA. LPA also observed that R1 had two (2) more small skin tears on their left hand. LPA's review of R1's medical prescriptions also determined that R1 has been taking Latanoprost which can cause skin rashes. Based on the LPA's observations and record reviews, staff and resident interviews conducted, the allegation(s) for physical abuse is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citation(s) issued, and a copy of this report was given to the Administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
LIC9099 (FAS) - (06/04)
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