197610191-10-22-2024-31-AS-TAGD-DB82GC-20241120162257

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610191
Report Date: 10/22/2024
Date Signed: 10/22/2024 02:22:49 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
10/16/2024 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20241016115656

FACILITY NAME:	GARDENS AT NORTHRIDGE, THE		FACILITY NUMBER:	197610191
ADMINISTRATOR:	LISA VILLASENOR		FACILITY TYPE:	741
ADDRESS:	17650 WEST DEVONSHIRE STREET		TELEPHONE:	(818) 886-1616
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	135	CENSUS: 90	DATE:	10/22/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Lisa Villasenor		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Staff did not prevent a resident from falling and sustaining injuries while in care
Staff illegally evicted a resident in care

INVESTIGATION FINDINGS:

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On 10/22/24, at 9:45am, Licensing Program Analysts (LPAs) Gina Saucedo and Angelica Segovia arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Executive Director, Lisa Villasenor. LPA explained the purpose of this visit was to gather information and deliver findings for this complaint.

On 10/22/24, LPA Saucedo asked for the census, staff, and resident rosters. On 10/22/24, LPA Saucedo interviewed staff and residents and conducted a physical tour.

LIC 9099C-continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

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-20241016115656

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: GARDENS AT NORTHRIDGE, THE	FACILITY NUMBER: 197610191
	VISIT DATE: 10/22/2024

NARRATIVE

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Regarding the allegation: Staff did not prevent a resident from falling and sustaining injuries while in care. It is being alleged that one (1) of the residents has had multiple falls and sustained injuries while in care. LPA's reviewed Resident #1 (R1)’s file and proper documentation was sent to CCLD-Community Care Licensing Department regarding R1’s falls and injuries. On 06/30/24, it was reported that R1 was laying on the floor next to their sofa area complaining of their forehead hurting and was sent to the hospital for an ankle injury. On 10/08/24, R1 had fallen and was sent to the hospital resulting in a tear near their left eye. On 10/08/24, R1 was sent again for the same injury due to their eye not getting properly treated. Furthermore, R1's resident plan shows R1 is a fall risk. Three (3) staff confirmed that R1’s health has been deteriorating. R1 was ambulatory and is now non-ambulatory and needs help with assisted daily living activities. Nine (9) out of nine (9) residents confirmed that emergency calls are made for them, and they are sent to the hospital if they feel ill or sustain any injuries. Therefore, based on the LPA's record reviews, staff and resident interviews the above allegation(s) above is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff illegally evicted a resident in care. It is being alleged that resident #1 (R1) is being evicted. LPA confirmed with three (3) staff that R1 is not being evicted but the staff also confirmed that R1’s health and behavior has changed within the last couple of months. Since June of 2024, R1 has been at two (2) different Skilled Nursing Facilities. R1 was sent to a Skilled Nursing Facility in June and was allowed to return to the above facility. R1 returned to the hospital again in October and the hospital transferred R1 to another Skilled Nursing Facility. R1 continues to be the Skilled Nursing Facility and has not returned back to the above facility. Nine (9) out of nine (9) residents confirmed that they are aware of the eviction process, reasons for eviction and are not aware of any residents being illegally evicted. Therefore, based on the LPA's record reviews, staff and resident interviews the above allegation(s) above is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citation(s) were issued for the above allegation(s), and a copy of this report was given to the Resident Care Director.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

LIC9099 (FAS) - (06/04)

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