<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610025
Report Date: 07/24/2024
Date Signed: 07/24/2024 03:10:45 PM


Document Has Been Signed on 07/24/2024 03:10 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:PACIFICA SENIOR LIVING NORTHRIDGEFACILITY NUMBER:
197610025
ADMINISTRATOR:IVY MITCHELL SHARPFACILITY TYPE:
740
ADDRESS:8700 LINDLEY AVENUETELEPHONE:
(818) 886-5181
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:110CENSUS: 86DATE:
07/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Ivy SharpeTIME COMPLETED:
03:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 07/24/24 at 9:25AM, Licensing Program Analyst (LPA) Gina Saucedo and Licensing Program Manager (LPM) Troy Agard arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo and LPM Agard met with the Administrator, Ivy Sharpe and disclosed the purpose of the visit.

LPA asked for the census, resident, and staff rosters and files. A physical tour was conducted at 11:15AM and observed the following:

The entire facility has a total of 110 (one-hundred and ten) beds. Forty-three (43) are currently in the memory care unit and 44 (forty-four) in the Assisted Living area being occupied. All the rooms are on the second floor. The floor is divided by assisted living and memory care. The assisted living is on your left-hand side of the facility and the memory care is on your right-hand side of the facility. The second floor consists of a medication room which is in the memory care section. The memory care section has their own activity, dining hall, enclosed patio and enclosed garden. There is also a delayed egress on the doors. The assisted living side has their own activity room upstairs. The assisted living side has access to the ground level which is the first floor which has the laundry room area, beauty salon, dining hall, kitchen access to the patio area, another activity room area and a staff lounge. The parking structure can be entered from this area.

Random Bedrooms and Bathrooms were randomly selected to tour and were observed to have appropriate furniture, lightening, bedding, and televisions. Random Bathrooms were observed to have grab bars and non-skid mats. Hot water temperature was tested randomly for and measured 110–115-degree Fahrenheit.

The chemicals are inaccessible to the residents which can be accessed via the kitchen area in a locked door.

LIC 809C-continued
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina SaucedoTELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: PACIFICA SENIOR LIVING NORTHRIDGE
FACILITY NUMBER: 197610025
VISIT DATE: 07/24/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Fire extinguishers were observed throughout the facility and were fully charged on green with the same expiration dates- July 2025. There are fire extinguishers upstairs, downstairs, in the kitchen area and parking lot structure. Carbon Monoxide and fire sprinklers are located throughout the facility and are operable.

Facility has a designated medication room that is inaccessible to residents where all the medication is stored and locked in the memory care side of the facility. The medication was revised randomly.

The assisted living area: outside/backyard is accessible to residents with different areas for them to sit. There is appropriate outdoor furniture for the residents to sit on with proper shading. There is no bodies of water.

Common Areas: These include the dining areas, beauty salon, and activities room. All common areas were observed to be cleaned and properly furnished. The activity room has a large television and has enough seating for several residents to watch the television and do different activities. Facility maintains a comfortable temperature of in between 74 and 75-degree Fahrenheit. There are several temperature thermostats throughout the facility. There are several common bathrooms throughout the upstairs and downstairs area. The staff and resident bathrooms are not shared. There are trash cans with lids and covid signs posted in the common bathrooms. There is toilet paper and napkins.

The Kitchen area was toured, and LPA and LPM observed there to be sufficient seven (7) day supply of non-perishable foods and perishable food for all residents. There is a large freezer divided into two (2) compartments. The kitchen area was clean at the time of the tour.

Administrative: There is no annual fee that is due right now. The Insurance plan is current and dated 2025. There is a disaster plan, licensee certificate, YES sign, Ombudsman, Theft and Loss Policy, Resident Rights, and Rights of Resident Council. against the wall facing the entrance of the facility. The last fire drill conducted was on 06-/2024.

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

SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina SaucedoTELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2