197606676-6-6-2025-31-AS-NMAN-DP9U9L-20251211142320

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606676
Report Date: 06/06/2025
Date Signed: 06/06/2025 11:10:51 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
05/04/2025 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20250504210228

FACILITY NAME:	BROOKDALE GARDENS OF TARZANA		FACILITY NUMBER:	197606676
ADMINISTRATOR:	HELEN LEE		FACILITY TYPE:	740
ADDRESS:	18700 BURBANK BLVD		TELEPHONE:	(818) 342-0003
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	90	CENSUS: 69	DATE:	06/06/2025
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Mario Preston		TIME COMPLETED:	11:25 AM

ALLEGATION(S):

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Staff unlawfully evicted a resident
Staff coerced a client to sign unauthorized notice while in care

INVESTIGATION FINDINGS:

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At approximately 8:45 a.m. on 06/06/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and disclosed the reason for the visit.

Prior to this investigation, LPA reviewed the eviction notice of Resident #1 (R1) at approximately 4:00 p.m. on 05/01/25. To further investigate the allegations, LPA conducted an initial visit on 05/08/25 and toured the facility inside and out at 2:05 p.m., interviewed staff between 2:15 p.m. and 2:45 p.m., and conducted a record review of pertinent records, including but not limited to an admission agreement, medical assessment, and staff and client rosters at 2:45 p.m. Today, LPA and toured the facility inside and out at 8:50 a.m., interviewed staff between at 9:20 a.m. and 10:00 a.m., and conducted a record review of eviction-related paperwork and emergency contacts at 9:30 a.m.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025

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-20250504210228

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BROOKDALE GARDENS OF TARZANA	FACILITY NUMBER: 197606676
	VISIT DATE: 06/06/2025

NARRATIVE

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Regarding the allegation "Staff unlawfully evicted a resident" it was alleged R1 was evicted unlawfully. Record review of the eviction notice revealed the facility issued R1's eviction on 04/30/25 which met all requirements of Title 22, Division 6, Chapter 8, Article 4, Subsection 87224 Eviction Procedures. Interview with Staff #1 (S1) at 2:15 p.m. on 05/08/25 confirmed that the eviction notice was hand-delivered to R1 on 04/30/25. Additionally, the eviction notice was sent via certified mail to R1’s representative and faxed the notice to Community Care Licensing in a timely manner. LPA reviewed an Affidavit of Hand Delivery which R1 signed and confirmed receipt of the eviction notice with the Executive Director and S1. LPA also reviewed the certified mail receipt from 04/30/25 sent to R1’s representative at the address provided. Interview with Staff #2 (S2) at 2:40 p.m. on 05/08/25 also confirmed that the eviction notice was hand-delivered to R1 and sent via certified mail to their representative. Based on interviews and record review, the staff did not unlawfully evict R1. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation "Staff coerced a client to sign unauthorized notice while in care " it was alleged staff coerced R1 to sign a 30-day eviction notice. LPA did not interview R1 at the request of their representative. Interview with S1 revealed R1 voluntarily signed the notice of hand-delivery. S1 noted R1’s signature was requested for the facility’s due diligence in ensuring all parties received the notice in a timely manner. Record review of the Affidavit of Hand Delivery from 04/30/25 revealed that the notice stated the Executive Director served the 30-day notice to pay or quit for amounts due from October 2024 to April 2025. Based on interviews and record review, although the allegation is valid, the investigation yielded no evidence of coercion of R1. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health or safety concerns were observed during today’s visit.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2025

LIC9099 (FAS) - (06/04)

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