197610186-8-18-2022-31-AS-EMIR-CJ2MU6-20220907095433

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610186
Report Date: 08/18/2022
Date Signed: 08/18/2022 02:46:28 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
08/15/2022 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20220815100604

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: 45	DATE:	08/18/2022
		UNANNOUNCED	TIME BEGAN:	08:48 AM
MET WITH:	Sherene Thomas, Kamal Grewal		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility is not properly managing issue with pests
Floors are unsanitary throughout the facility
Facility call button system is in disrepair
Facility does not provide planned activities for residents
Facility serves food of low quality to residents
Facility does not have sufficient resources to meet operating costs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPA met with Sherene Thomas, Health and Wellness Director (HWD), and spoke with Kamal Grewal, Chief Operations Officer (COO) over the telephone. They were advised of the reason for this visit. During the course of the investigation, LPA conducted interviews with staff and residents, a physical plant tour inspecting random resident rooms and common areas, observation of facility activities and food service. LPA also obtained facility records.

Facility is not properly managing issues with pests:
In regards to the allegation, it's being alleged that the faciity has problems with roaches, spiders, mosquitos and other small bugs. Interviews made with the HWD and the COO indicate that the facility is serviced for pest control at least twice a month. Copies of invoices and statements obtained to confirm services are being made. No indication of infestation per review. Interviews were conducted with residents

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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-20220815100604

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: 08/18/2022

NARRATIVE

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who gave no indications that there is an infestation of rodents or insects. Furthermore, LPA conducted an inspection of the physical plant, checking resident rooms and common areas. No insects or rodents were observed. Based on the information obtained, there was insufficient evidence to corroborate the allegation of facility having issues with pests. Therefore the allegation is deemed Unsubstantiated at this time.

Floors are unsanitary throughout the facility :
In regards to the allegation, it's being alleged that the carpets throughout the facility are dirty and stained. It's also alleged that resident rooms have rodent droppings. Interviews with the HWD and the COO indicate that resident rooms are being serviced and clean once a week or as needed. Interviews with resident confirm that their rooms are cleaned every week, or as needed. LPA conducted a walk through and inspected resident rooms and common areas. During the plant inspection, LPA observed housekeeping being done. LPA did not observed dirt and stained carpeting. LPA also did not observed any rodents or rodent droppings. Based on the LPA's interviews and physical plant inspection, facility appears to be clean safe and sanitary at this time. There was insufficient evidence to corroborate with the allegation. Therefore, the allegation is deemed Unsubstantiated at this time.

Facility call button system is in disrepair:
In regards to the allegation, it's reported that the resident pendant call buttons are faulty and doesn't work very well. Interviews with the HWD and COO confirm that the facility operates with a pendant for resident's to use for assistance. Once the pendant is activated, a signal is sent to staff's beeper, indicating the need for assistance. During the day's visit, LPA Cava and the HWD tested random pendents in resident rooms and common areas. LPA observed the pendents to be functional, with staff responding within a reasonable time. Based on the testing conducted by the LPA, there was insufficient evidence to corroborate the allegation of the facility call button being in disrepair. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20220815100604

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: 08/18/2022

NARRATIVE

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Facility does not provide planned activities for residents:
In regards to the allegation, it's being reported that the facility does not have any recreational activities. Upon entering the facility, LPA observed the activity director conducting some virtual bowling with some resident participation. At the lobby area, LPA observed a posting for today's events, which include walking club, virtual bowling, Documentary: Secrets of The Great Wall of China, Crossword Club, Current Affairs Talk, Daily News and Movie. LPA obtained a copy of the facility's monthly events calendar and reviewed a month's worth of activities. Interviews made with residents also reveal no complaints that there are no planned activities being offered. Based on the information obtained, there was insufficient evidence to corroborate the allegation of no planned activities for the residents in care. Therefore, the allegation is deemed Unsubstantiated at this time.

Facility serves food of low quality to residents:
In regards to the allegation, it was reported that the food and beverage service are bad and low quality. LPA Cava conducted an inspection of the kitchen and food service. LPA observed the food and food preparation, which did not appear to be of low quality. LPA spoke with the head cook, who indicated there were no complaints or concerns made to him regarding food being bad and of low quality. Both the HWD and COO stated they haven't received any complaints regarding the food service. LPA also conducted interviews with residents, who did not express any complaints regarding food being bad and of low quality. Based on the information obtained, there was insufficient evidence to corroborate the allegation of facility serving food of low quality to the residents. Therefore, the allegation is deemed Unsubstantiated at this time.

Facility does not have sufficient resources to meet operating costs:
In regards to the allegation, it's being alleged that the licensee is behind in paying their bills, resulting in short staffing and no internet service. LPA conducted interviews with residents, who did not indicate a shortage with staff. All residents confirmed that their needs are being met, and are never being felt neglected. Furthermore, the residents did not express any complaints or concerns with interruption from their utilities or internet service. LPA obtained a copy of staff schedule and the LIC 500 to confirm there are sufficient staffing. Per interviews with the HWD and COO, utility and internet bills are paid accordingly to insure no interruption with services. LPA received an email transaction from the COO confirming that the internet is in service. LPA also obtained a copy of DWP/utility statements to insure bills are being met. Based on the information obtained, there was insufficient evidence to corroborate the allegation. Therefore, investigation is Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

LIC9099 (FAS) - (06/04)

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