197602414-6-23-2021-31-AS-NMAN-C6B26K-20210827170715

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602414
Report Date: 06/19/2021
Date Signed: 06/23/2021 10:30:11 AM

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
04/27/2020 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20200427155120

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: 58	DATE:	06/19/2021
		UNANNOUNCED	TIME BEGAN:	08:21 AM
MET WITH:	Francisco Orozco - Maintenance Manager		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not safeguard resident’s property

Staff are not providing residents with food of good quality

Nutritious meals are not being provided to residents

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 Manager on Duty Francisco Orozco and explained the reason for the visit.

LPA conducted physical plant tour at around 9:20 AM. LPA also requested copy of facility documents relevant to the investigation. At 10:35 AM, LPA interviewed staff and residents of the facility. Regarding the allegation that the facility staff did not safeguard resident's property, LPA record review revealed that there was no property/valuables listed on Resident Personal and Property Valuables list inventory. LPA interview with Resident #1 (R1) confirmed that R1 did not declare any valuable to the facility upon admission and unable to provide proof of existence of missing items. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time.

(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: 06/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2021

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-20200427155120

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: 06/19/2021

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation that staff are not providing residents with food of good quality, LPA interview with nine (9) residents (or 15% of total census) revealed that seven (7) residents believe that the quality of the food being served at the facility is okay or good. LPA record review and observation also revealed that the facility provides complete meal with fruit and vegetable servings on every meal and staff interview reveals that kitchen staff also customize food being served upon resident's request.

Regarding the allegation that nutritious meals are not being provided to residents, LPA record review revealed that the facility has a quarterly dietician's audit and the last one was done on 02/19/2020 and was temporarily halted due to pandemic. LPA record review also revealed that the monthly menu are varied and daily menu provides options and alternate option for the residents to choose. LPA interview with nine (9) residents however revealed that four (4) out of nine (9) residents believe that the facility do not provide healthier options.

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: 06/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2021

LIC9099 (FAS) - (06/04)

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