197602414-4-14-2021-31-AS-CHAS-C4G2WE-20210629174526

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602414
Report Date: 04/14/2021
Date Signed: 04/14/2021 04:02:29 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
11/24/2020 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20201124142214

FACILITY NAME:	BROOKDALE NORTH TARZANA		FACILITY NUMBER:	197602414
ADMINISTRATOR:	DAVIS, DINA		FACILITY TYPE:	740
ADDRESS:	5711 RESEDA BLVD		TELEPHONE:	(818) 996-2022
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	135	CENSUS: 69	DATE:	04/14/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Anchirriza Concebcion		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility does not serve food of the quality needed to meet residents’ needs.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Wendell Smith conducted a subsequent complaint visit regarding the allegation above. Due to the situation surrounding the Corona virus Disease 2019 (COVID-19) and to implement mitigation measures, today’s case management visit was conducted telephonically with staff Anchirriza Concebcion.
Regarding the allegation above the initial complaint visit was conducted on 12/3/2020. The complaint came in on 11/20/2020. It is alleged that the facility does not serve food of the quality needed to meet the resident's needs. LPA had previously invesigated this allegation with regards to complaint control number 31-AS-20200508135312. LPA previously interviewed residents and took a virtual tour of the food supply. Today LPA conducted a tour of the kitchen for the ability to prepare and store food. LPA observed there to be a sufficient amount of perishable and non perishable food with different options. Based on the information obtained during observation and an interview with the complainant who stated the food has been fine and there is no issue with the food this allegation is deemed Unsubstantiated at this time. Exit Interview conducted. Copy of report emailed for signature.

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: 04/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021

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