197610186-3-21-2023-31-AS-NMAN-CQVPD3-20230414111253

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610186
Report Date: 03/21/2023
Date Signed: 03/21/2023 01:58:16 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
02/21/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20230221103246

FACILITY NAME:	SUMMIT ASSISTED LIVING OF TARZANA		FACILITY NUMBER:	197610186
ADMINISTRATOR:	JODI KANOWITZ		FACILITY TYPE:	740
ADDRESS:	5711 RESEDA BLVD		TELEPHONE:	(415) 710-7538
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	135	CENSUS: 36	DATE:	03/21/2023
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Sherene Thomas		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff handled resident in a rough manner

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 handled resident in a rough manner

Regarding the allegation above, it was alleged staff handled Resident #1 (R1) in a rough manner. LPA interviewed staff and residents on 03/01/2023 from 10:55 a.m. to 2:00 p.m. Staff interviewed stated they have not handled residents roughly nor heard of any other staff handling residents roughly. Residents interviewed had no concerns of staff handling residents roughly or inappropriately. LPA interviewed R1 on 03/21/2023 at 12:40 p.m. R1 stated staff have never handled them in a rough manner. R1 had no complaints about the care provided by the facility. Based on interviews, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (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)

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