197602414-3-18-2022-31-AS-MVAO-CKLTDL-20221027143832

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602414
Report Date: 03/18/2022
Date Signed: 03/18/2022 05:57:45 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:	0	CENSUS: 52	DATE:	03/18/2022
		UNANNOUNCED	TIME BEGAN:	09:02 AM
MET WITH:	Jodi Kanowitz - Executive Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Waste baskets are not being emptied in a timely manner.

Residents are not provided activities

Resident’s requests for assistance are not being responded to in a timely manner

Facility is short staffed

INVESTIGATION FINDINGS:

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

LPA conducted physical plant tour at 10:00 AM, requested copies of facility documents relevant to the investigation at 10:30 AM and conducted additional interview with the Executive Director, staff and residents of the facility between 10:30 to 12:30 PM.

Regarding the allegation that waste baskets are not being emptied in a timely manner, it was alleged that the waste baskets in resident's rooms are not being emptied. LPA's interview with staff revealed that it is part of their routine to take the trash on every resident's room assigned to them and they do it regularly. LPA's interview with seven (7) residents during prior visits on 12/17/21 between 11:00 AM to 1:30 PM and 02/03/22 between 10:45 AM to 1:00 PM, revealed that staff are taking their trash regularly in a timely manner. (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: 03/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022

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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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: 03/18/2022

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation that Residents are not provided activities, it was alleged that residents don’t have any activities anymore, except movies and outing once a week. LPA's record review during prior visits on 12/17/21 at 10:30 AM and 02/03/22 at and revealed that the facility has activity calendar and observed that during visits on 12/17/21, 02/03/22 and today's visit, there were ongoing activities with the residents such as live entertainment, Shabbat services and exercises as per the activity calendar. LPA's interview with seven (7) residents also revealed that six (6) out of seven (7) residents believe that they are getting sufficient activities given the current situation. LPA's interview with ED on 02/03/22 at 12:30 PM also revealed that due to Covid 19 restrictions, the activities were limited but continued within the existing guidelines and protocols.

Regarding the allegation that Resident’s requests for assistance are not being responded to in a timely manner, it was alleged that staff took so long to respond to call button. LPA's interview with seven (7) residents during prior visits on 12/17/21 between 11:00 AM to 1:30 PM and 02/03/22 between 10:45 AM to 1:00 PM and additional two (2) residents during today's visit between 11:30 AM to 12:40 AM, revealed that six (6) out of nine (9) residents believe that staff come in within reasonable time whenever they press their call button. LPA's observation during today's and prior visits also revealed that staff respond to a call button between three (3) minutes to eleven (11) minutes.

Regarding the allegation that Facility is short staffed, it was alleged that there are staff shortages at this facility, LPA's interview with seven (7) residents during prior visits on 12/17/21 between 11:00 AM to 1:30 PM and 02/03/22 between 10:45 AM to 1:00 PM and additional two (2) residents during today's visit between 11:30 AM to 12:40 AM, revealed that six (6) out of nine (9) residents believe that there are sufficient staff at this facility and they get sufficient care from the staff. LPA's interview with three (3) staff during prior visit on 12/17/21 between 11:00 AM to 1:30 PM revealed that two (2) out of three (3) staff interviewed believe that they have sufficient staff and could carry the workload on their shift and they get additional assistance if needed.

Based on the information gathered during this and prior visits, 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: 03/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022

LIC9099 (FAS) - (06/04)

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