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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197602414
Report Date:
09/10/2021
Date Signed:
09/10/2021 01:35:59 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
08/25/2021
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20210825104916
FACILITY NAME:
BROOKDALE NORTH TARZANA
FACILITY NUMBER:
197602414
ADMINISTRATOR:
DANA ANDERSON
FACILITY TYPE:
740
ADDRESS:
5711 RESEDA BLVD
TELEPHONE:
(818) 996-2022
CITY:
TARZANA
STATE:
CA
ZIP CODE:
91356
CAPACITY:
135
CENSUS:
58
DATE:
09/10/2021
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Dana Anderson
TIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to treat resident with dignity and respect
Staff failed to provide a comfortable environment for resident
Staff failed to assist resident in a timely manner
Staff failed to meet resident’s needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent visit to finish investigation into the allegations above. LPA met with the administrator and explained the reason for this visit.
LPA conducted an previous visit on 8/27/21 regarding the allegations above.
Regarding the allegations above resident # 1 (R1) feels that facility staff fail to treat them with dignity and respect and that facility staff don't assist them in a timely manner which doesn't provide a comfortable environment for them and that the facility fails to meet their needs.
From approximately 10:10am through 10:50 am LPA conducted an interview with R1 regarding the allegations above. LPA also conducted interviews with various staff from 10:50am-11:15 am regarding the allegations above. Information from interviews reveal that there was some miscommunication between R1 and facility staff which caused R1 to feel like they weren't being assisted in a timely manner. R1 stated that facility staff assist them in a timely manner and that they are very independent. R1 stated they felt that staff were very helpful and that the miscommunication during one incident did not mean that their needs weren't met or they were not treated with dignity and respect.
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:
09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/10/2021
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
2
Control Number
31-AS-20210825104916
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:
09/10/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on the information obtained through interviews these four allegations are deemed Unsubstantiated at this time. Exit Interview conducted.
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/10/2021
LIC9099
(FAS) - (06/04)
Page:
2
of
2