197610142-4-21-2022-31-AS-EMIR-CEBS8S-20220511133938

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610142
Report Date: 04/21/2022
Date Signed: 04/21/2022 03:05:23 PM

Unfounded

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
04/20/2022 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20220420125546

FACILITY NAME:	ATRIA TARZANA		FACILITY NUMBER:	197610142
ADMINISTRATOR:	RAFAT, SHAKEB		FACILITY TYPE:	740
ADDRESS:	5325 ETIWANDA AVENUE		TELEPHONE:	(877) 483-6827
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	136	CENSUS: 110	DATE:	04/21/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Angela Bademyan		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility did not assess residents prior to admission.
Facility did not provide 60-day notice prior to rent increase.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit at facility to investigate the above allegations. LPA met with staff Angela Bademyan and advised them of the visit. During the course of the investigation, interviews and record review was made.

Facility did not assess residents prior to admission:
In regards to the allegation, it was reported that no assessments were made for Residents 1 and 2 (R1 and R2). According to Ms. Bademyan, an assessment was made for both R1 and R2. A review of R1 and R2 files indicate a Functional Needs Assessment was made on 8/9/2021 to determine compatibility. Interviews were also made with both R1 and R2 during their appraisal. Staff stated both residents are independent, as indicated on their assessment. LPA obtained a copy of their admission agreement, Functional Needs and Assessment and physician's report for record. Based on the information obtained, there was insufficient evidence to corroborate the allegation of facility not assessing Resident 1 and Resident 2. Therefore, the investigation is Unfounded at this time.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

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-20220420125546

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: ATRIA TARZANA	FACILITY NUMBER: 197610142
	VISIT DATE: 04/21/2022

NARRATIVE

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Facility did not provide 60-day notice prior to rent increase
In regards to the allegation, it was reported that both R1 and R2 were paying $7,200 a month. In January 2022, the facility increased their rent to $8,064 for R1 and $8,564 for R2. RP stated they did not receive a notice of rent increase. According to staff, residents and their responsible parties were made aware of the increase. Furthermore, at admission, residents and their responsible parties are notified of an annual increase pursuant to Health and Safety Code 1569.658. In addition to the admission agreement, a letter was sent out to R1 and R2's responsible party on 10/28/21 advising them of their increase which would take effect on 1/1/2022. Copies of both R1 and R2 were obtained for record. Per review, it was confirmed that the annual increase was disclosed on the admission agreement (page 37), and a letter was sent out for both residents indicating the increase on 10/28/21. Based on the information obtained, there was insufficient evidence to corroborate the allegation of facility not providing a 60 day notice of rental increase. Therefore, the allegation is Unfounded at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

LIC9099 (FAS) - (06/04)

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