197602414-6-10-2020-31-AS-MVAO-BQMTUA-20200616150201

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602414
Report Date: 06/10/2020
Date Signed: 06/10/2020 04:14:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/02/2020 and conducted by Evaluator Wendell Smith

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20200602135614

FACILITY NAME:	BROOKDALE NORTH TARZANA		FACILITY NUMBER:	197602414
ADMINISTRATOR:	DAVIS, DINA		FACILITY TYPE:	740
ADDRESS:	5711 RESEDA BLVD		TELEPHONE:	(818) 996-2022
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	135	CENSUS: 82	DATE:	06/10/2020
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Dina Davis		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility failed to provide a comfortable environment for resident

Activities are not offered.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wendell Smith initiated a complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Administrator Dina Davis.

Facility failed to provide a comfortable environment for resident
It is alleged that resident # 1 (R1) has complained about resident # 2(R2) dog barking constantly and keeping R1 up at odd hours and the facility not doing anything about it. LPA conducted interviews with R1, other residents, and facility staff. Information from interviews show that the facility has offered both R1 and R2 the opportunity to move rooms but both declined. LPA spoke with other residents in the same living area who stated that R2's dog does not disturb any of them. Facility has kept an eye on the situation and has determined that no community rules have been broken by R2. Facility continues to work with both R1 and R2 to help alleviate any issues.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2020

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-20200602135614

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BROOKDALE NORTH TARZANA	FACILITY NUMBER: 197602414
	VISIT DATE: 06/10/2020

NARRATIVE

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Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.

Activities are not offered.
It is alleged that there are no activities offered by the facility. LPA conducted interviews with residents and staff. Information from interviews revealed that since the onset of Covid-19 the facility does not offer as many activities due to wanting to social distance and keep residents safe. Interviews with residents did show that the facility still conducts art class, ceramic class, and two movies a day. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.
A telephonic exit interview was conducted with Administrator Dina Davis and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2020

LIC9099 (FAS) - (06/04)

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