197602414-2-3-2022-31-AS-MVAO-CKLTDM-20221027143832

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602414
Report Date: 02/03/2022
Date Signed: 02/03/2022 02:42:06 PM

Unsubstantiated

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
12/14/2021 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20211214083559

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: 52	DATE:	02/03/2022
		UNANNOUNCED	TIME BEGAN:	09:38 AM
MET WITH:	Dana Anderson - Executive Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident’s belongings are being stolen.

Food is being prepared in an unsafe manner

Residents are being provided inadequate food services

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to investigate the above allegations. LPA met with Executive Director Dana Anderson and explained the reason for the visit.

LPA conducted physical plant tour at 10:00 AM, requested copy of facility documents relevant to the investigation at 10:30 AM and interviewed staff and residents between 10:45 AM to 1:00 PM. Regarding the allegation that residents' belongings are being stolen, it was alleged staff are taking or stealing personal items in at least three (3) residents' room (no identifier was provided by the complainant). LPA's interview with seven (7) residents or more than 10% of residents currently living at the facility on 12/17/21 between 11:00 AM to 1:30 PM and today between 10:45 AM to 1:00 PM revealed that seven (7) out of seven (7) residents interviewed did not have missing or stolen personal belongings. This allegation was also investigated and unsubstantiated on prior complaint with complaint control no.: 31-AS-20210824145555 with the report dated 09/10/21 (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022

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 3

Control Number 31-AS-20211214083559

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: 02/03/2022

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

(continued from LIC 9099)

Regarding the allegation that Food is being prepared in an unsafe manner, it was alleged that an uncooked fish was served to a resident. LPA's observation during physical plant tour on 12/17/21 at 10:40 AM and today at 11:45 AM while preparing lunch for residents revealed that all kitchen staff are wearing food protective gear while preparing food. LPA's record review at 12:30 PM, also revealed that kitchen staff are trained in safe food handling, further review also revealed that no resident was hospitalized due to food poisoning in the past three (3) months. LPA's interview with the Food Services Director also revealed that they prepare and cook their food in compliance with the strictest food handling safety rules including but not limited to measuring the temperature of every meat and fish while cooking before they serve the food.

Regarding the allegation that Residents are being provided inadequate food services, it was alleged that some residents are not being provided with proper diet as prescribed and the facility does not follow their own menu. LPA's observation during prior and today's visit revealed that residents who have prescribed dietary prescription are prominently displayed in the kitchen with their corresponding dietary restriction. LPA also observed during today's visit at 11:45 AM during lunch preparation that staff separately prepared the food for residents' with prescribed dietary restriction. LPA's record review today at 12:30 PM also revealed that the kitchen has the physician's order for all the residents' with dietary restriction and all the food served today were the ones described on the monthly menu.

Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3