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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610025
Report Date: 08/18/2025
Date Signed: 08/18/2025 01:04:31 PM

Substantiated


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
08/13/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250813164015
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: 73DATE:
08/18/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Frances Norberte, Memory Care DirectorTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff did not adequately supervise residents resulting in residents ingesting non-food items
INVESTIGATION FINDINGS:
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On 08/18/25, at 9:20am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Frances Norberte, Memory Care Director. LPA explained the purpose of this visit was to gather information, interview staff and residents and deliver findings for this complaint.

On 08/18/25, LPA Saucedo asked for the census, staff, and resident rosters. On 08/18/25, at 10:30am, LPA Saucedo conducted a physical tour and interviewed staff and residents.

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

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
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 3
Control Number 31-AS-20250813164015
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: 08/18/2025
NARRATIVE
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Regarding the allegation: Staff did not adequately supervise residents resulting in residents ingesting non-food items. It is being alleged that some residents in memory care were left unsupervised and were eating crayons and drinking water from a paint container. LPA interviewed four (4) out of four (4) staff that confirmed they have seen staff #1 (S1) from memory care leave the residents unattended. Four (4) staff confirmed that S1 from memory care walks around and leaves the residents unattended while the residents stay in the Activities Room for unknown amounts of time. One (1) staff confirmed that they have witnessed a resident eating crayons before. LPA attempted to interview residents in the memory care area of the facility but to no avail they were able to answer any of the LPA questions. Therefore, based on the LPA's observations, staff and resident interviews, the above allegation(s) above is SUBSTANTIATED at this time.


An exit interview was conducted, citation(s) were issued, appeal rights was given and a copy of this report was given to the Memory Care Director.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250813164015
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/19/2025
Section Cited
HSC
1569.269(a)(6)
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Enumerated rights; severability
(a) Residents of residential care facilities for the elderly shall have all of the following rights: (6) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met by:

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The Licensee/Administrator shall properly train the staff #1 (S1) to care and supervise the residents in memory care.

POC 08/19/25
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Based on the LPA observation and interviews the licensee/administrator did not ensure the safety of the residents in memory care by leaving them unattended and residents eating crayons which poses an immediate Health, Safety or Personal Rights risks to persons in care.
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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: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3