197610025-9-23-2026-31-AS-TAGD-DYMNWS-20261007105001

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610025
Report Date: 09/23/2026
Date Signed: 09/23/2026 01:12:29 PM

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
08/07/2026 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20260807145701

FACILITY NAME:	NORTHRIDGE VALLEY SENIOR LIVING		FACILITY NUMBER:	197610025
ADMINISTRATOR:	BENEDICT PAK		FACILITY TYPE:	740
ADDRESS:	8700 LINDLEY AVENUE		TELEPHONE:	(818) 886-5181
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	110	CENSUS: 77	DATE:	09/23/2026
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Benedict Pak, Executive Director		TIME COMPLETED:	01:12 PM

ALLEGATION(S):

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Staff illegal evicted a resident
Staff did not safeguard resident's cash
Staff did not provide adequate incontinence care, resulting in infection
Staff did not respond to residents pleas for help
Licensee does not staff adequately to met residents' needs

INVESTIGATION FINDINGS:

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On 09/23/26, at 9:25am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Benedict Pak, Executive Director. LPA explained the purpose of this visit was to gather additional information, conduct interviews and deliver findings regarding this complaint.

On 08/13/26, Licensing Program Analyst (LPA) Jose Gary Tan conducted the 10-day, Initial visit. On 09/23/26, at 10:25am, LPA Saucedo conducted a physical tour, interviewed staff and residents and delivered findings.

LIC 9099C-continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026

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-20260807145701

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: 09/23/2026

NARRATIVE

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Regarding the allegation: Staff illegally evicted a resident. It is alleged that resident #1 is being illegally evicted. During LPA’s interview with R1’s two (2) relatives they confirmed that besides paying $3500.00 for the admission down payment they had not made any payments towards R1 residing at the above facility because they were waiting for a waiver that they signed up for to be processed that would pay for R1’s rent. Upon reviewing R1 ‘s admission agreement R1 started to reside at the above facility in 12/2025 and did not make any payments towards their rent. R1 also received a fee waiver on 11/04/25 for $3500.00 that would cover the first month’s rent which was confirmed by R1’s two (2) relatives. Furthermore, an eviction notice was provided to R1 and their family on 03/17/26 for the amount of non-payment of $25,553.23 and R1 still resided at the facility until 09/03/26 without non-payment of rent. LPA interviewed staff #1 (S1) and staff #2 (S2) and both confirmed along with R1’s two (2) relatives that there was no rent payment made therefore an eviction notice and legal detainer was provided to R1 and their family. Let it be noted, LPA attempted to interview another staff # 3 (S3) that helped R1 and R1’s relatives with the admission agreement but S3 no longer worked at the above facility. LPA also interviewed the waiver program that R1 applied for and they also confirmed that they did not make payments towards R1's rent. Therefore, based on the interviews conducted and LPA's record review the allegation(s) is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff did not safeguard resident's cash. It is alleged that $3500.00 in cash was provided to a staff member and the money was not safeguarded for Resident #1 (R1). LPA interviewed R1’s two (2) relatives and they admitted that $3500.00 was given to a staff member at the above facility in cash but could not provide any receipts or proof to LPA. During LPA’s interview with Staff #1 (S1) and staff #2 (S2), both staff confirmed that they did not know about any $3500.00 given to a staff member in cash because the $3500.00 entrance fee was waived and did not understand why the $3500.00 would be given to someone if the first month was waived. During LPA’s record review of R1’s admission agreement it does confirm that $3500.00 was waived and it was signed and dated on 11/04/25 prior to R1’s admission agreement on 12/09/25 by one (1) of R1’s relatives. Let it be noted, LPA attempted to interview another staff # 3 (S3) that helped R1’s and R1’s relatives with the admission agreement and waiver fee but S3 no longer works at the above facility. LPA also attempted to interview another of R1's relative that knew about the $3500.00 cash but they did not return LPA's multiple calls. Therefore, based on the interviews conducted and LPA's record review the allegation(s) is UNSUBSTANTIATED at this time.

LIC 9099C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20260807145701

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: 09/23/2026

NARRATIVE

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Regarding the allegation: Staff did not provide adequate incontinence care, resulting in infection. It is alleged that resident #1 (R1) developed a UTI-Urinary Tract Infection because of the lack of incontinence care. During LPA’s interview with two (2) of R1’s relatives they said that R1 went to Northridge Hospital in June of 2026 for a UTI caused by lack of incontinence care. One (1) relative said they were at the hospital during R1’s stay and thought R1 had a UTI. Another relative said they were told that R1 had a UTI by a relative but never confirmed any paperwork and/or went to the hospital to visit R1. During LPA’s review of the Unusual Incident/Injury Report for June 11, 2026, it confirmed that R1 was sent to Northridge Hospital for shortness of breath and lethargy. The discharge papers that were reviewed and obtained by LPA confirmed that R1 was at Northridge Hospital on June 11, 2026 for pneumonia, acute metabolic encephalopathy, atrial fibrillation, acute hyperkalemia and diabetes mellitus. Furthermore, the Preplacement Appraisal confirmed that R1 had a history of pneumonia and UTIs and had gone prior to going to live at the above facility in October of 2025. During LPA’s interview with staff #1 (S1) and staff #2 (S2), both staff confirmed that R1 went to the hospital in June of 2026, for Shortness of Breath and Lethargy which resulted being pneumonia. S2 also confirmed that R1 had SCAN-Health Plan that would do doctor visits with R1 at the facility and they would have let the staff know that R1 had a UTI. LPA reviewed some of the SCAN visits and none of the paperwork diagnosed R1 with a UTI but did diagnose R1 with Hypertension and Wheezing on different visits. Therefore, based on the interviews conducted and LPA's record review of Northridge Hospital the allegation(s) is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff did not respond to residents’ pleas for help. It is alleged that residents are heard screaming for help. During LPA’s physical tour, LPA did not witness and/or hear any of the residents pleading for help. Furthermore, LPA observed caregivers and housekeepers helping the residents. LPA interviewed three (3) caregivers that confirmed they help the residents whenever they ask for it and when they press their pendant alarms. LPA interviewed seven (7) residents that confirmed they have not heard any pleas from other residents and when they press their pendant alarm, they receive help. In addition, LPA pressed one (1) pendant alarm and witnessed a caregiver help a resident within a few seconds. Therefore, based on the interviews conducted and LPA's physical tour the allegation(s) is UNSUBSTANTIATED at this time.

LIC 9099C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20260807145701

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: 09/23/2026

NARRATIVE

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Regarding the allegation: Licensee does not staff adequately to meet residents' needs. It is alleged that resident #1 (R1) was left on their bed half-naked on a cold pad, because they were very understaffed. During LPA’s interview with staff #1 (S1) and staff #2 (S2) they both confirmed that there are several staff that work different shifts. One (1) staff confirmed that there is four (4) staff in the Assisted Living and four (4) staff in the memory care in the mornings and there is four (4) staff in Assisted Living and four (4) staff in memory care in the afternoons and there is two (2) staff in Assisted Living and two (2) staff in memory care at NOC-Night (Graveyard shift). LPA interviewed an additional three (3) staff, caregivers that confirmed there is adequate staffing to meet the needs of the residents. The three (3) caregivers confirmed that R1 was never left half-naked on a cold pad and also now needed two (2) staff to help them and that their incontinence care and their observation of R1 had changed to several times a day. Let it be noted, R1 is no longer residing at the above facility and did not get interviewed but LPA did attempt to interview R1 upon their transfer to another facility but R1's family refused to have LPA speak to them. LPA interviewed seven (7) residents that confirmed their needs are met by staff. In addition, LPA pressed one (1) pendant alarm from a resident and witnessed a caregiver help a resident within a few seconds which confirmed the resident’s needs are being met within adequate time frames. LPA also obtained and reviewed R1's Preplacement and Resident Appraisal, Needs and Services Plan and Medical Assessment which confirmed R1's needs had changed while residing at the above facility and now needed a two (2) staff assist versus one (1) staff assist. R1's relatives also confirmed that R1's health was deteriorating and needed more help. Therefore, based on the interviews conducted and LPA's physical tour the allegation(s) is UNSUBSTANTIATED at this time.

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

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026

LIC9099 (FAS) - (06/04)

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