197602414-1-11-2022-31-AS-MVAO-CHMQEP-20220825120641

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602414
Report Date: 01/11/2022
Date Signed: 01/11/2022 10:49:53 AM

Unfounded

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
01/06/2022 and conducted by Evaluator Alexander Pitz

COMPLAINT CONTROL NUMBER: 31-AS-20220106081018

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: 55	DATE:	01/11/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Dana Andersen		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

1
2
3
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5
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7
8
9

Staff did not provide resident a reasonable level of personal privacy in accommodations

INVESTIGATION FINDINGS:

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2
3
4
5
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7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Pitz conducted an unannounced visit on this day in response to the above allegation.
During this investigation LPA interviewed the complainant telephonically at 8:00am on 1/11/22; interviewed the administrator and reviewed relevant facility records at 10:15am on 1/11/22.

Allegation #1, that "Staff did not provide resident a reasonable level of personal privacy in accommodations," has been deemed unfounded as a result of the interviews conducted. The sequence of events that prompted this complaint, as told by both the complainant, the administrator and in recorded staff statements, did not amount to a violation of resident personal rights. Futhermore, the complainant stated during interview that they would like to retract this complaint. Report reviewed, signed and delivered. Exit interview conducted, no deficiencies cited. A finding of unfounded means the allegation is false, could not have happened, and/or is without a reasonable basis.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Alexander Pitz	TELEPHONE: (805) 450-1627
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2022

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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