197602414-8-3-2020-31-AS-MVAO-BS8NDX-20200806102304

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602414
Report Date: 08/03/2020
Date Signed: 08/03/2020 02:43:05 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
05/08/2020 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20200508135312

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: 74	DATE:	08/03/2020
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Dina Davis		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff not treating residents with respect
Staff are not providing residents with food of good quality
Staff are not giving residents privacy
Staff confiscated resident’s medication.

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.
Staff not treating residents with respect
It is alleged that the administrator has yelled at residents and staff. LPA conducted interviews with residents and staff regarding this allegation. Interviews revealed that residents and staff feel the administrator treats residents and staff with respect and has not yelled at anyone in particular. Based on the information obtained through interviews this allegation is deemed Unsubstantiated.

Staff are not providing residents with food of good quality
LPA obtained copies of food menus provided to residents. LPA also conducted interviews with various residents regarding food service.

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: 08/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2020

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-20200508135312

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: 08/03/2020

NARRATIVE

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Interviews conducted with various residents reveal that they have no issue with food served to them. Based on the information obtained from interviews this allegation is deemed Unsubstantiated at this time.

Staff are not giving residents privacy
It is alleged that administrator is not providing residents privacy. LPA conducted an interview with residents regarding this allegation along with the administrator. Interviews revealed that administrator will visit with residents to see how their doing during this pandemic situation but will not speak with residents against their wishes. Based upon the information obtained through interviews this allegation is deemed Unsubstantiated at this time.

Staff confiscated resident’s medication.
It is alleged that staff confiscated resident #1 (R1) medication. LPA interviewed R1 who stated that they misplaced their medication but did originally think staff took it. Based on the information obtained this allegation is deemed Unsubstantiated at this time.

Exit Interview conducted. Copy of report sent to administrator for signature.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2020

LIC9099 (FAS) - (06/04)

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