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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610025
Report Date: 10/17/2026
Date Signed: 10/18/2026 08:25:41 AM

Document Has Been Signed on 10/18/2026 08:25 AM - 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:NORTHRIDGE VALLEY SENIOR LIVINGFACILITY NUMBER:
197610025
ADMINISTRATOR/
DIRECTOR:		BENEDICT PAKFACILITY TYPE:
740
ADDRESS:8700 LINDLEY AVENUETELEPHONE:
(818) 886-5181
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 110CENSUS: 76DATE:
10/17/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:52 AM
MET WITH:Ruchelle Umali - Business Office ManagerTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced One (1) year Required visit to this facility. LPA met with Business Office Manager Ruchell Umali and explained the purpose of this visit.

A tour of the physical plant was conducted at 9:34 AM and the following was observed:

The entire facility has a total of 110 (one hundred and ten) beds. Thirty six (36) residents are currently in the memory care unit and forty (40) residents in the Assisted Living. All the rooms are on the ground floor. The memory care section has their own activity area, dining hall, two (2) enclosed patio and enclosed gardens. There are four (4) delayed egress in memory care. The assisted living side has two (2) activity rooms, one the ground and another in basement area. The basement area has beauty salon, dining hall, kitchen and patio area and a staff lounge. The parking structure is also located in the basement. Fire extinguishers were observed all throughout in the facility hallways and observed to be fully charged and last bought on 10/17/26. The facility is equipped with fire sprinklers system and pull system. There are Carbon Monoxide detectors installed at the facility. The facility's smoke alarms are hard wired and interconnected and back up and tests are done in house on a monthly basis. The facility is fire cleared for 110 non-ambulatory residents, 30 of which maybe bedridden. Hospice waiver for 20 residents.

Residents' Bedrooms and Bathrooms were toured and observed to have appropriate furniture, lighting, bedding, and televisions. Random bathrooms were observed to have grab bars and non-skid mats. Hot water temperature was tested and measured at a range of 107.7°F to 118.9°F. Residents' bedroom and bathroom had pull cord alarms. (continued on LIC 809-C)
Troy Agard
Jose Gary Tan
DATE: 10/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: NORTHRIDGE VALLEY SENIOR LIVING
FACILITY NUMBER: 197610025
VISIT DATE: 10/17/2026
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(continued from LIC 809)

Medication room is located in the Memory Care area on the ground floor. There is a refrigerator with lock in the medication room to store medicine that requires refrigeration. Medication room is locked at all times. Medication and medication records were reviewed for proper storage and documentation. There are three (3) medication carts for the Assisted Living residents and three (3) carts for the Memory Care residents. There are two (2) complete First aid kits in the medication room.



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 between 75.0°F to 77.0°F. The staff and resident bathrooms are not shared. Trash cans are with cover. There is no body of water in the facility. Laundry area is located in the basement area. Laundry detergent, cleaning solutions and other toxins are observed to be locked in the storage area by the parking area.

Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning agents and other toxins were separated away from the food preparation area. Dietary restrictions for residents are displayed in the kitchen.

Resident Files: LPA conducted a file review of six (6) random residents, residents' record appear to be complete and updated.
Staff Files: LPA also conducted a file review of six (6) staff records. Staff records appear to be complete and updated. Disaster drill was last conducted on 09/19/26. Required posting observed in facility (complaint hot line poster, personal rights, etc).

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of this Report Issued.
NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Jose Gary Tan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2026
LIC809 (FAS) - (06/04)
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