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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610186
Report Date: 09/20/2022
Date Signed: 09/20/2022 11:19:29 AM

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
09/15/2022 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20220915140657
FACILITY NAME:SUMMIT ASSISTED LIVING OF TARZANAFACILITY NUMBER:
197610186
ADMINISTRATOR:JODI KANOWITZFACILITY TYPE:
740
ADDRESS:5711 RESEDA BLVDTELEPHONE:
(415) 710-7538
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY:135CENSUS: 42DATE:
09/20/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sherene Thomas, Carmelita RoxasTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility water temperture not in compliance with licensing regulation.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegation. It was reported that the water pressure in resident bathrooms is very low and the water temperature runs either very hot or very cold. During the course of the investigation, LPA met and interviewed the Executive Director, Sherene Thomas, and the Health and Wellness Director, Carmelita Roxas, and explained to them the purpose of the investigation. In addition, LPA conducted a physical plant inspection and interviewed residents.

Between 9:45am to 10:45am, the LPA checked the water temperature of ten (10) resident rooms between the first, second and third floors. The water temperature on the first floor measured between 107.2 to 116 degrees F. The water on the second floor measured between 105 to 120 degrees F, and the water on the third floor measured between 105.3 to 118.6 degrees F. In addition to checking the water temperature, and LPA Cava held interviews with ten (10) of ten (10) residents while in their rooms. There were no
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022
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 2
Control Number 31-AS-20220915140657
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: 09/20/2022
NARRATIVE
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resident complaints or concerns expressed about water pressure being too low, or being to hot or cold.

Based on the information obtained, there was insufficient evidence to corroborate the allegation of the water temperature not in compliance with licensing regulation. Therefore, the allegation is deemed Unsubstantiated at this time.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2