197610186-11-22-2023-31-AS-NMAN-CZK297-20240116161125

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610186
Report Date: 11/22/2023
Date Signed: 11/22/2023 03:58:20 PM

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
04/07/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20230407114201

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:	0	CENSUS: 53	DATE:	11/22/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Jina Maleksarkissians		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility operating without Administrator
Facility does not have hot water

INVESTIGATION FINDINGS:

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At 8:30 a.m. on 11/22/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced, subsequent complaint visit. LPA met with the administrator and disclosed the reason for the visit. LPA toured the facility at 8:45 a.m.

To investigate the allegation listed above, LPA conducted an initial visit at approximately 2:00 p.m. on 04/13/2023 and toured the facility at 2:30 p.m., interviewed Staff #1 (S1) at 2:45 p.m., and reviewed pertinent records at 3:00 p.m. During a subsequent visit at 8:30 a.m. on 11/01/2023, LPA interviewed ten percent of residents, or six (06) out of fifty-three (53) residents and five (05) staff members between 8:30 a.m. and 3:00 p.m.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2023

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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Control Number 31-AS-20230407114201

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: SUMMIT ASSISTED LIVING OF TARZANA	FACILITY NUMBER: 197610186
	VISIT DATE: 11/22/2023

NARRATIVE

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Regarding the allegation “Facility does not have hot water”, it was alleged that the facility did not have hot water for 3 days on or prior to April of 2023. Interview with Resident #1 (R1) at 10:00 a.m. on 11/01/2023 and Resident #3 (R3) at 2:15 p.m. on 11/01/2023 revealed they had not experienced issues with facility hot water. Interview with Resident #2 (R2) at 10:20 a.m. on 11/01/2023 revealed the hot water went out in June. Interview with S1 revealed that the health department visited the facility to test the water and everything was okay. Interview with Staff #2 (S2) at 11:30 a.m. on 11/01/2023 revealed the hot water was out, but S2 was not sure when. Interview with Staff #3 (S3) at 3:00 p.m. on 11/01/2023 revealed the hot water was out, but the issue was fixed. Interview with Staff #4 (S4) at 8:45 a.m. on 11/01/2023 revealed the hot water boiler went out in April for a few days due to an employee intentionally turning it off. The new management put a lock on the boiler so the issue would not reoccur. LPA tested the water temperature in Room #111 at 2:35 p.m. on 04/13/2023 to be 105.6 degrees Fahrenheit. Based on interviews, the water boiler was out in April, but it is uncertain if residents were negatively impacted by a lack of hot water. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Facility operating without Administrator” it was alleged the facility operated for several days with no Administrator since the previous Administrator resigned. During the facility tour at 2:30 p.m. on 04/13/2023, LPA observed a valid and current administrator certificate belonging to Nirjara Acharya posted at the main entrance. LPA spoke with Licensee representatives Alan Graza and Nirjara Acharya at approximately 3:15 p.m. on 04/13/2023. Both individuals confirmed that Nirjara was serving as an administrator and Executive Director. A file review conducted at 11:40 a.m. today revealed the licensee submitted the proper paperwork to the Licensing Department on 04/04/2023 confirming Nirjara as the facility administrator. Based on interviews, observations, and record review, the facility was not operating without an administrator. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety hazards were noted during this visit.

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

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2023

LIC9099 (FAS) - (06/04)

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