197603823-4-21-2026-31-AS-NMAN-DUXQL7-20260611121528

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603823
Report Date: 04/21/2026
Date Signed: 04/21/2026 02:24:10 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
09/17/2025 and conducted by Evaluator Antonia Alvizar-Ettima

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20250917150613

FACILITY NAME:	NORTH LAKE VILLAS INC.		FACILITY NUMBER:	197603823
ADMINISTRATOR:	NOURIT BRAUN		FACILITY TYPE:	740
ADDRESS:	2851 N. LAKE AVE		TELEPHONE:	(626) 398-8668
CITY:	ALTADENA	STATE: CA	ZIP CODE:	91001
CAPACITY:	30	CENSUS: 22	DATE:	04/21/2026
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Adam Braun - Assistant Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff are not following refund conditions
Staff did not ensure resident received P & I money

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Antonia Alvizar- Ettima conducted an unannounced subsequent visit to complete an investigation and deliver findings of the above noted allegations. LPA met with Med-Tech and explained the reason for the visit. The Assistant Administrator later joined today’s visit

During initial visit on 09/22/2025 due to the destruction of North Lake Villas, Inc. by fire, the complaint visit was conducted at 10:35 am by Licensing Program Analyst (LPA) Tihesha Smith at Encino Terrace Senior Living Adult Residential, a facility that residents from North Lake Villas were relocated. LPA Smith met with staff and disclosed the purpose of the visit. LPA Smith conducted an interview with a licensee via telephone, requesting documents relevant to the investigation to include but not limited to a copy of admissions agreement, personnel report, staff schedule, resident roster.

Prior to this visit on 03/13/26 LPA Alvizar- Ettima conducted an interview with Assistant Administrator and
Cont. on LIC 9099

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026

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-20250917150613

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: NORTH LAKE VILLAS INC.	FACILITY NUMBER: 197603823
	VISIT DATE: 04/21/2026

NARRATIVE

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Cont. from LIC 9099
Staff #1 (S1) via telephone, request documents relevant to the investigation payable check to social Security Administration and P& I in behalf of R1 and other documents obtained from the facility.
During this visit at approximately 9:30a.m., LPA Alvizar- Ettima and Med-Tech conducted a physical plan tour and did not observe any immediate health and safety issues. Between 10:45a.m. – 12:45p.m LPA interviews with Resident #2 - #3 (R2 - R3) and Med-Tech staff.

1.) Staff are not following refund conditions

It was alleged that Assistant Administrator received a payment and did not follow proper refund procedures. Assistant Administrator interview revealed that Resident (R1) relocated mid-month and that the Social Security Office was not provided with sufficient time to update the payee information. The Assistant Administrator reported that the payment was returned to the Social Security Administration in accordance with their instructions. Resident #2 (R2) stated that they have not experienced issues related to refunds and reported receiving refund payments as applicable. Additional resident interviewed did not express concerns related to the allegation. Staff #1 (S1) and Med-Tech interviews confirmed the information provided by Assistant Administrator. Records reviewed revealed that R1’s funds were returned to the Social Security Administration.

Based on interviews, information obtained and record review, there is insufficient evidence to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

2.) Staff did not ensure resident received P & I money

It was alleged that R1 have not received Personal and Incidental (P & I) money. Assistant Administrator and staff denied the allegation. The Assistant Administrator reported that that Resident (R1) consistently received P& I money and that any remaining funds were returned upon moving out of the facility. Resident #2 (R2) stated they were roommates with R1 for an extended period and reported that R1 did not express concerns regarding P & I money . R2 also reported receiving their own P & I money in full and on time. Additional resident interview did not report concerns related to P & I money. Staff #1 (S1) and Med-Tech interviews corroborated with Assistant Administrator’s statements. Records reviewed indicated that R1 received P & I money as required.

Based on interviews, information obtained, and record review, there is insufficient evidence to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit Interview conducted/Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026

LIC9099 (FAS) - (06/04)

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