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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610186
Report Date: 03/21/2023
Date Signed: 03/21/2023 01:57:46 PM

Unsubstantiated


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
02/22/2023 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20230222112100
FACILITY NAME:SUMMIT ASSISTED LIVING OF TARZANAFACILITY NUMBER:
197610186
ADMINISTRATOR:JODI KANOWITZFACILITY TYPE:
740
ADDRESS:5711 RESEDA BLVDTELEPHONE:
(415) 710-7538
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY:135CENSUS: 36DATE:
03/21/2023
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Sherene ThomasTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff left resident locked outside for extended period of time
INVESTIGATION FINDINGS:
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At 12:40 p.m. on 03/21/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the Administrator and disclosed the reason for the visit.

Staff left resident locked outside for extended period of time

Regarding the allegation above, it was alleged Resident #1 (R1) was locked out of the facility. LPA interviewed staff and residents on 03/01/2023 from 10:55 a.m. to 2:00 p.m. and on 03/21/2023 from 12:40 p.m. to 1:30 p.m. Staff interviewed did not recall the specific incident. Residents interviewed mentioned no issue with being locked out of the facility. Staff stated the front doors are locked from the outside around 6:00 p.m. each night for the safety of the residents. The facility maintains a log of residents who go in and out of the facility. LPA reviewed the resident log at 12:50 p.m. on 03/21/2023. A phone number and a doorbell are posted at the main entrance.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023
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
Control Number 31-AS-20230222112100
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: SUMMIT ASSISTED LIVING OF TARZANA
FACILITY NUMBER: 197610186
VISIT DATE: 03/21/2023
NARRATIVE
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Staff stated they are able to hear the doorbell, and they carry the phone on them during the evening and overnight shifts. At 12:55 p.m. on 03/21/2023, LPA and Administrator tested the doorbell. The Resident Services Director answered the front door promptly and stated the ring was heard from the second floor. Based on interviews and observations, although the allegation may have happened, there is insufficient evidence to prove a violation of regulations. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Appeal rights discussed. Copy of report provided.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2