197610186-3-15-2024-31-AS-NMAN-D67MV3-20240613095603

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610186
Report Date: 03/15/2024
Date Signed: 03/15/2024 03:31:51 PM

Substantiated

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
10/27/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20231027141614

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: 0	DATE:	03/15/2024
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Rita Meldonian		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Staff financially abused of multiple residents

INVESTIGATION FINDINGS:

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At 10:25 a.m. on 03/15/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced, subsequent complaint visit. LPA met with the administrator of Savant of Tarzana (197610366) and disclosed the reason for the visit.

Regarding the allegation “Staff financially abused of multiple residents” It was alleged that Staff #1 (S1) stole and forged personal checks belonging to Resident #1 (R1) and Resident #2 (R2) and stole the credit card of Resident #3 (R3).

To investigate the allegation, LPA conducted an initial visit on 11/01/2023 and interviewed three (03) staff between 8:45 a.m. and 2:30 p.m. and reviewed records pertinent to the investigation at 4:45 p.m. including but not limited to R3’s face sheet and employee files of S1 and a former Executive Director (ED1). LPA telephonically interviewed family of residents and former staff between 8:45 a.m. and 10:30 a.m. on 11/08/2023.

Substantiated

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: 03/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024

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 3

Control Number 31-AS-20231027141614

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: 03/15/2024

NARRATIVE

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The case was referred to Investigator Eleza Jackson of the Investigations Branch on 11/14/2023. LPA interviewed a Los Angeles County District Attorney (DA) at 4:50 p.m. on 11/16/2023. The DA sent LPA files pertinent to the investigation at 9:00 p.m. on 11/27/2023 including but not limited to a list of checks stolen by S1 and a court document regarding S1’s theft. LPA received and reviewed the results of the Investigations Branch report at approximately 10:00 a.m. on 01/23/2024.

Interview with ED1 at 8:45 a.m. on 11/08/2023 revealed that S1 resigned from the facility in December 2022. A family member (F1) had called the police for the theft of R2’s checks. ED1 also reported that the Executive Director before them (ED2) had filed a report after a family member called stating Resident #4 (R4) in the room next to R1, was missing their credit card. Interview with ED2 at 9:10 a.m. on 11/08/2023 revealed they had no memory of financial abuse or theft at the facility. Interview with F1 at 10:30 a.m. on 11/08/2023 confirmed R2 had 4 checks stolen over 2 months. Interviews with Staff #2 (S2) at 8:45 a.m. on 11/01/2023 and Staff #3 (S3) at 11:30 a.m. on 11/01/2023 revealed staff were aware of two (02) personal checks belonging to R3 were missing. S3 reported it to ED2 and observed that two checks were missing from R3’s checkbook. Interview with the DA revealed S1 financially abused three (03) to four (04) victims at Summit Assisted Living of Tarzana and Leisure Vale Retirement Hotel (191290642). Record review of documents sent from the DA included a document from court case LA099516 which revealed S1 stole forty (40) checks totaling $23,290.00 from R1, four (04) checks totaling $1,680.18 from R2, one (01) check in the amount of $350.00 from R3, and one (01) check in the amount of $130.34 from Resident #5 (R5). Record review of reports obtained by the Investigation’s Branch revealed Adult Protective Services investigated the case (Case #231007885) and arrested S1 at approximately 7:00 a.m. on 06/15/2023. S1 confirmed to investigators that they had deposited residents’ checks into their personal account. LPA also reviewed photocopies of approximately thirty (30) checks taken from R1 and R2 which were forged by S1. Based on interviews and record review, S1 stole and forged checks from multiple residents at the facility, and facility staff and an administrator were aware of theft within the facility. Therefore, the allegation is deemed SUBSTANTIATED at this time. A deficiency is issued on the attached LIC 809-D page.

No immediate health and safety risks were observed 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: 03/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20231027141614

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/15/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/15/2024 Section Cited CCR 87468.2(a)(8)	1 2 3 4 5 6 7	87468.2 Additional Personal Rights... (a) In addition...residents... have all of the following personal rights: (8) To be free from... financial exploitation	1 2 3 4 5 6 7	The administrator of the current licensed faciltiy of the same address agreed to provide an in-service training on financial exploitation to staff and send proof by the POC due date.
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee did not comply with the section cited above in four (04) out of at least thirty (30) residents which posed an immediate Health, Safety, or Personal Rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024

LIC9099 (FAS) - (06/04)

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