<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197602414
Report Date:
08/27/2021
Date Signed:
08/27/2021 12:13:45 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:
57
DATE:
08/27/2021
UNANNOUNCED
TIME BEGAN:
09:30 AM
MET WITH:
Nananne Elchermueller
TIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to provide adequate food service
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced initial complaint visit to investigate the allegations above. LPA met with facility staff and explained the reason for this visit.
Regarding the allegation above it is alleged that facility does not provide nutrionally balanced meals to the residents at the facility. LPA conducted a previous complaint visit on 8/20/21 with complaint control number 31-AS-20210819151828 and one of the allegations was regarding staff failing to provide adequate food service. LPA conducted interviews with various residents and took a physical plant tour of the kitchen. LPA also observed lunch being served to residents. The finding on the allegation was Unsubstantiated. During today's visit LPA took a tour of the facility kitchen and observed lunch being prepared. LPA also obtained a copy of the facility menu that is provided to residents. Due to the same allegation already being investigated and both allegations being made within five days of each other this allegation is still Unsubstantiated. Based on interviews and observation it appears the food served is of good quality with different options for residents. Exit Interview conducted.
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:
08/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/27/2021
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