197602414-9-10-2021-31-AS-NMAN-C7B2EV-20210928172036

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602414
Report Date: 09/10/2021
Date Signed: 09/10/2021 01:35:33 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
08/24/2021 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20210824145555

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:	12:00 PM
MET WITH:	Dana Anderson		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility does not have planned activities for the residents
Staff did not safeguard resident's personal property

INVESTIGATION FINDINGS:

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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.

Facility does not have planned activities for the residents
Regarding this allegation it is alleged the facility does not have planned activities. LPA spoke with the administrator and obtained the activities calendar for the facility. From approximately 12-12:30pm, LPA conducted interviews with various residents regarding activiites. Information from interviews reveal that the facility does have plenty of activities throughout the day for residents. During the visit LPA observed a musician come and play for the residents. Based on the information obtained through interviews and observation this allegation is deemed Unsubstantiated at this time.

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)

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Control Number 31-AS-20210824145555

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

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Staff did not safeguard resident's personal property
It is alleged that facility did not safeguard resident #1 (R1) umbrella which went missing over a year ago. LPA conducted an interview with R1 and also obtained a copy of R1's personal property/valuable log. Based on the information obtained through interview and documents obtained this allegation is deemed Unsubstantiated at this time. There is not enough information to state that the facility did not safeguard R1's property as it was not documented on their personal property log.
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)

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