197606676-5-25-2021-31-AS-CHAS-C4EQJC-20210628121231

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606676
Report Date: 05/25/2021
Date Signed: 05/25/2021 01:21:40 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
05/24/2021 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20210524081809

FACILITY NAME:	BROOKDALE GARDENS OF TARZANA		FACILITY NUMBER:	197606676
ADMINISTRATOR:	MNATSAKANYAN, LILIT		FACILITY TYPE:	740
ADDRESS:	18700 BURBANK BLVD		TELEPHONE:	(818) 342-0003
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	90	CENSUS: 43	DATE:	05/25/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Hasmik Sargsyan		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Resident sustained multiple injuries while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced initial complaint visit to investigate the allegation above. LPA met with Hasmik Sargsyan (Health and Wellness Director) and explained the reason for this visit.

It is alleged that resident # 1 (R1) sustained multiple pressure injuries while in care. R1 was admitted to the hospital on 5/20/21 for their injuries. LPA conducted an interview with facility staff and reviewed medical documentation related to R1. Information from interview and review of medical documentation show that R1 was admitted to this facility on 5/21/21 from the hospital and that R1 was at another facility when they were hospitalized for their injuries. Based on the information obtained this allegation is deemed Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.
Exit interview conducted.

Unfounded

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: 05/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2021

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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