197610186-3-1-2023-31-AS-NMAN-CQVMEE-20230414093235

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610186
Report Date: 03/01/2023
Date Signed: 03/01/2023 02:56:14 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 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: 37	DATE:	03/01/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Sherene Thomas		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Facility vehicle is in disrepair

INVESTIGATION FINDINGS:

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At 10:45 a.m. on 03/01/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the Administrator and disclosed the reason for the visit.
Regarding the allegation above, it was alleged the facility vehicle has been out of service for an extended period of time. LPA interviewed the Administrator at 10:55 a.m., conducted a records review at 11:15 a.m. and toured the facility at 11:45 a.m. No immediate health or safety concerns were observed. From 11:45 a.m. to 2:00 p.m. LPA interviewed residents. From interviews, the Administrator confirmed the vehicle has been out of service and is beyond repairing. The facility has accommodated residents by arranging rideshare transportation. Residents confirmed rideshares were arranged for appointments. From record reviews, the Administrator showed receipts of approximately 10 arranged transportations for residents from January and February of 2023. Although the vehicle is in disrepair, the facility has sufficiently accommodated residents’ transportation needs. Based on interviews and record reviews, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANIATED at this time. Exit interview conducted. 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: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

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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