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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610191
Report Date: 08/02/2022
Date Signed: 08/02/2022 03:08:13 PM


Document Has Been Signed on 08/02/2022 03:08 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:GARDENS AT NORTHRIDGE, THEFACILITY NUMBER:
197610191
ADMINISTRATOR:KESHISHYAN,VARSENIKFACILITY TYPE:
741
ADDRESS:17650 WEST DEVONSHIRE STREETTELEPHONE:
(818) 886-1616
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:135CENSUS: DATE:
08/02/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Carl Knepler and Deidre Schonfeldt TIME COMPLETED:
02:30 PM
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On 08/02/22 a virtual meeting was conducted in regard to the licensure for The Gardens at Northridge. Participants in meeting included the following:
  • Kit Chan- Assistant Program Administrator DSS
  • Nichelle Gillyard- Licensing Program Manager DSS
  • Joscelyn Martinez- Licensing Program Analyst DSS
  • Allison Nakatomi- Staff Service Manager I for Continuing Care Retirement Care
  • Hao Nguyen- Staff Service Manager II for Centralized Application Bureau
  • Craig Lundgren- DSS Attorney
  • Shelly Grace- Assistant Branch Chief DSS
  • Carl Knepler- Senior VP Operations Pacifica Senior Living
  • Deidre Schonfeldt- Pacifica Senior Living

Community Care Licensing Division (CCLD) has received documentation outlining Pacifica Senior Living Compliance Plan for this facility. Staff has been informed that Licensing Program Analyst will conduct frequent unannounced during the first twelve (12) months of licensure to esnure facility is in compliance and following regulations. CCLD does not have any other concerns at the moment and will grant the license. Pacica Senior Living staff have agreed to ensure facility will be in compliance and all staff will following regulations.

Report will be emailed for a hard signature. Copy of report with signature will be filed.

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn MartinezTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2022
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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