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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610191
Report Date: 05/20/2023
Date Signed: 05/20/2023 03:28:21 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
11/03/2022 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20221103163702
FACILITY NAME:GARDENS AT NORTHRIDGE, THEFACILITY NUMBER:
197610191
ADMINISTRATOR:MANDY TAYLORFACILITY TYPE:
741
ADDRESS:17650 WEST DEVONSHIRE STREETTELEPHONE:
(818) 886-1616
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:135CENSUS: 75DATE:
05/20/2023
UNANNOUNCEDTIME BEGAN:
08:49 AM
MET WITH:Desire Lopez - Manager on DutyTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff are not providing food of the quality necessary to meet residents' needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent visit at this facility to further investigate the above allegations. LPA met with Manager on Duty Desire Lopez and explained the reason for the visit.

LPA conducted physical plant tour at 9:20 AM, requested copy of facility documents relevant to the investigations at 10:00 AM and interviewed residents and staff between 10:30 AM to 1:30 PM. LPA also conducted record review between 1:30 PM to 2:40 PM. Regarding the allegation that Staff are not providing food of the quality necessary to meet residents' needs, it was alleged that the food that the facility served is not good anymore. LPA's observation during today's visit revealed that the facility seem to provide a well balance meal with protein and vegetables on their today's menu. LPA also observed that those who did not like the menu for today could always order from the facility's Always Available menu like variety of sandwiches and salad and eggs. (continued to LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2023
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 5
Control Number 31-AS-20221103163702
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: GARDENS AT NORTHRIDGE, THE
FACILITY NUMBER: 197610191
VISIT DATE: 05/20/2023
NARRATIVE
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(continued from LIC 9099)

LPA's interview today between 10:30 AM to 1:30 PM with ten (10) residents or more than 10% of the current census, revealed that Seven (7) out of ten (10) residents did not like and believed that the quality of food the facility is serving is average to below average and only three (3) out of ten residents believed that the food is of good quality.

Based on the information gathered during this and prior visit, the allegation is deemed substantiated at this time.

Citation issued. Appeal rights discussed and given. Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20221103163702
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: GARDENS AT NORTHRIDGE, THE
FACILITY NUMBER: 197610191
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/03/2023
Section Cited
CCR
87555(8)
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(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained.

This requirement is not met as evidenced by:
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Manager on Duty agreed to inform the management to submit a plan to address the food issue and submit the same on or before the POC date.
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Based on LPA's interview 7 out of 10 residents did not like the food and believed that the food served is not of good quality. This poses a potential risk to the residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
11/03/2022 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20221103163702

FACILITY NAME:GARDENS AT NORTHRIDGE, THEFACILITY NUMBER:
197610191
ADMINISTRATOR:MANDY TAYLORFACILITY TYPE:
741
ADDRESS:17650 WEST DEVONSHIRE STREETTELEPHONE:
(818) 886-1616
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:135CENSUS: 75DATE:
05/20/2023
UNANNOUNCEDTIME BEGAN:
08:49 AM
MET WITH:Desire Lopez - Manager on DutyTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
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5
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8
9
Staff are not following resident's admission agreement.

Staff are not providing transportation necessary to meet residents' needs.
INVESTIGATION FINDINGS:
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3
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5
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10
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13
Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent visit at this facility to further investigate the above allegations. LPA met with Manager on Duty Desire Lopez and explained the reason for the visit.

LPA conducted physical plant tour at 9:20 AM, requested copy of facility documents relevant to the investigations at 10:00 AM and interviewed residents and staff between 10:30 AM to 1:30 PM. LPA also conducted record review between 1:30 PM to 2:40 PM. Regarding the allegation that the Staff are not following resident's admission agreement, it was alleged that Resident #1 (R1)'s admission agreement includes bus service. LPA Martinez's record review on 11/07/22 at 1:11 PM and LPA's record review today between 1:30 PM to 2:40 PM, revealed that the facility will provide transportation but the schedule and kind of vehicle is at the facility's discretion. LPA's interview with staff today between 10:30 AM to 1:30 PM revealed that the facility is providing transportation every Friday to go to the shopping mall or restaurant.
(continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20221103163702
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: GARDENS AT NORTHRIDGE, THE
FACILITY NUMBER: 197610191
VISIT DATE: 05/20/2023
NARRATIVE
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(continued from LIC 9099-A)

Further record review also revealed that a resident needed to sign up in advance for them to go with the transport. R1 did not sign up for the transportation since December of 2022.

Regarding the allegation that Staff are not providing transportation necessary to meet residents' needs, it was alleged that some of the residents who rely on the facility provided transportation to their appointments were not serviced by the facility transportation. LPA's record review today revealed that the facility provide transportation though on a more limited basis than it used to. LPA's interview with the facility driver today at 11:30 AM revealed that the staff drove residents regularly to do shopping and with special trips to doctor's appointment and other resident's errands. LPA Martinez's interview with R1 on 11/07/22 revealed that R1 did not miss any appointment due to lack of facility transportation.

Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5