197610186-11-16-2022-31-AS-RRAZ-CQ4PNZ-20230320112843

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610186
Report Date: 11/16/2022
Date Signed: 11/16/2022 02:53:44 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
11/10/2022 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20221110141738

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: 39	DATE:	11/16/2022
		UNANNOUNCED	TIME BEGAN:	09:13 AM
MET WITH:	Shareene Thomas, Carmelita Roxas		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility failed to provide a comfortable water temperature for resident
Facility is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegations. LPA met with the administrator, Shareen Thomas, Health and Wellness Director (HWD), Carmelita Roxas and advised her of the allegations. From approximately 9:13am to 10:30am, LPA conducted a physical plant inspection, checking the water pressure and taking the water temperature of resident rooms on floors one, two and three. In the process of checking the water in resident rooms, interviews were made with the residents there.

Facility failed to provide a comfortable water temperature for resident:
In regards to the allegation, it was reported that the water temperature from the bathroom sinks in resident rooms varies from too cold, to too hot. During the investigation, LPA checked the water temperature in the bathrooms of random resident rooms on the first, second and third floors. The water temperature measured ranged from 110-120 degrees. Furthermore, interviews with residents were held. These 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: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

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-20221110141738

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: 11/16/2022

NARRATIVE

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expressed no complaints of the water, coming out of their bathroom sink being too hot or too cold. Based on the information obtained, there was insufficient evidence to corroborate the allegation of facility not having comfortable temperature for residents. Therefore, the allegation is deemed Unsubstantiated at this time.

Facility is in disrepair:
In regards to the allegation, it was reported that the water pressure from the faucet in resident bathrooms are unsteady. During the course of the day's investigation, LPA checked the water pressure in random resident rooms, while testing the water temperature. Rooms were checked on the first, second and third floors. The LPA's observation of the water flow/stream appeared to be steady during the inspection. This was consistent in all the rooms the LPA tested. Interviews were also held with the residents in the rooms where the bathroom sink was tested, and there were no complaints made by these residents. Furthermore, the company maintenance addressed Resident 1's (R1) concern on at least four occasions, and a plumber was also hired to inspect the sink. Although there didn't seem to be anything wrong with the sink, it was replaced, per R1's demand. Based on the information obtained, there was insufficient evidence to corroborate the allegation of facility 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: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

LIC9099 (FAS) - (06/04)

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