197610191-10-31-2023-31-AS-TAGD-D3KUZR-20240321160158

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610191
Report Date: 10/31/2023
Date Signed: 10/31/2023 02:29:31 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.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
06/09/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230609122426

FACILITY NAME:	GARDENS AT NORTHRIDGE, THE		FACILITY NUMBER:	197610191
ADMINISTRATOR:	GENA GRUNDEIS		FACILITY TYPE:	741
ADDRESS:	17650 WEST DEVONSHIRE STREET		TELEPHONE:	(818) 886-1616
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	135	CENSUS: 81	DATE:	10/31/2023
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Cynthia Lara Vargas - Resident Services Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff failed to keep resident's room clean

Staff failed to provide a safe and comfortable environment for resident

Staff neglected resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan, Gina Saucedo and Leslie Ngo-Castaneda conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Resident Services Director Cynthia Vargas and explained the reason for the visit.

LPAs conducted a physical plant tour at 9:30 AM, requested copies of facility documents at 10:00 AM and interviewed residents and staff between 10:13 AM to 1:15 PM. Regarding the allegation that the facility staff failed to keep resident's room clean, it was alleged that Resident #1 (R1)'s room was not maintained. LPAs' observation during physical plant tour today at 9:30 AM revealed that the six (6) random bedrooms visited at the memory care unit were all clean and well organized. LPAs' interview with eight (8) random residents from Assisted Living sections or 10% of the current census revealed that eight (8) out of eight (8) residents interviewed stated that their room were cleaned regularly by the staff. LPA's interview with staff on 06/13/23 between 10:30 AM to 1:00 PM and today between 10:13 AM and 1:15 PM confirmed that Memory Care housekeeper clean residents' room with the help of care staff on a daily basis (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

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-20230609122426

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: 10/31/2023

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation Staff failed to provide a safe and comfortable environment for residents, it was alleged that R1's bedroom had urine all over the floor which may have led to R1 having a fall. LPA's interview with four (4) staff on 06/13/23 between 10:30 AM to 1:00 PM revealed that R1 had just an onset of incontinence and not yet used to wearing diapers and kept on removing it once the staff put it. Further interview also revealed that staff check on R1 on an hourly basis but refused a lot of care and assistance from staff.

Regarding the allegation that Staff neglected resident while in care, it was alleged that R1 was found inside own bathroom covered in urine and had dried fecal matter on legs. LPA's interview with four (4) staff on 06/13/23 between 10:30 AM to 1:00 PM revealed that R1 had just an onset of incontinence and not yet used to wearing diapers and kept on removing it once the staff puts it. Further interview also revealed that staff check on R1 on an hourly basis but refused a lot of care and assistance from staff.

Based on the information gathered during this and prior visit, these 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: 10/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

LIC9099 (FAS) - (06/04)

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