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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610025
Report Date: 08/06/2026
Date Signed: 08/06/2026 11:48:54 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
07/31/2026 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20260731133647
FACILITY NAME:NORTHRIDGE VALLEY SENIOR LIVINGFACILITY NUMBER:
197610025
ADMINISTRATOR:BENEDICT PAKFACILITY TYPE:
740
ADDRESS:8700 LINDLEY AVENUETELEPHONE:
(818) 886-5181
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:110CENSUS: DATE:
08/06/2026
UNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Benedit PakTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff wrongfully evicted resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an initial complaint visit and met with Executive Director Benedit Pak regarding the allegation that the facility wrongfully evicted a resident.
To investigate the complaint, LPA conducted interviews and obtained and reviewed documentation on 08/04/2026, 08/05/2026, and 08/06/2026, during visits occurring between 9:00 a.m. and 2:00 p.m. The investigation included a review of records pertaining to Resident #1 (R1), including the Admission Agreement, billing statements, and other relevant facility documentation.

Based on the information obtained, LPA determined that R1 was admitted to the facility on 05/29/2026. At the time of admission, the facility required payment of a prorated rent amount, a care plan fee, and a community fee. Documentation reviewed during the investigation showed that monthly rent for June and July had been paid; however, the prorated admission charges and community fee remained outstanding, resulting in an unpaid balance. (Cont'd LIC9099C)

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
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-20260731133647
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: 08/06/2026
NARRATIVE
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The Executive Director stated that the facility issued R1's representative a notice to pay outstanding fees, not an eviction notice. The Executive Director further advised that the facility would contact R1's representative to clarify the purpose of the notice and work toward resolving the outstanding balance.
Based on interviews, documentation reviewed, and the allegation that the facility wrongfully evicted a resident is Unsubstantiated.

Exit interview and copy of report provided to ED.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2