197610366-3-13-2024-31-AS-NMAN-D5HVHH-20240522162711

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610366
Report Date: 03/13/2024
Date Signed: 03/13/2024 03:55:58 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
09/29/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20230929140905

FACILITY NAME:	SUMMIT ASSISTED LIVING OF TARZANA		FACILITY NUMBER:	197610366
ADMINISTRATOR:	DAVID AGUINIGA		FACILITY TYPE:	740
ADDRESS:	5711 RESEDA BLVD		TELEPHONE:	(818) 996-2022
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	176	CENSUS: 60	DATE:	03/13/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Rita Meldonian		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not respond to resident's call button

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

At 8:45 a.m. on 03/12/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced, subsequent complaint visit. LPA met with staff and later the Executive Director (ED) and disclosed the reason for the visit.

Regarding the allegation “Staff do not respond to resident's call button” it was alleged staff did not respond to a resident’s request through the call system in a timely manner. To investigate the allegation above, LPA conducted an initial visit on 10/04/2023 and interviewed the former ED at 12:00 p.m., Staff #1 (S1) at 3:30 p.m., and Resident #1 (R1) at 4:00 p.m. LPA conducted a subsequent visit on 11/01/2023 and 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. on 11/01/2023. LPA conducted another subsequent visit on 02/20/2024 and interviewed four (04) staff between 3:00 p.m. and 3:30 p.m. LPA telephonically interviewed Staff #4 (S4) at 2:55 p.m. on 03/06/2024 and Staff #5 (S5) at 3:15 p.m. on 03/06/2024.

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: 03/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024

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 2

Control Number 31-AS-20230929140905

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: 197610366
	VISIT DATE: 03/13/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA conducted another subsequent visit on 03/08/2024 and interviewed seven (07) out of fifty-nine (59) residents, which was 10% of residents, and four (04) staff members between 8:45 a.m. and 1:00 p.m. Today, LPA interviewed Staff #7 (S7) at 10:15 a.m. and toured the facility at 9:30 a.m.

Interview with the former ED revealed caregivers, med techs, and the front desk are alerted on their pagers when a resident uses the call system. S1 confirmed the front desk receives alerts and can notify caregivers of the location of the call. Interview with R1 at 4:00 p.m. on 10/04/23 revealed R1 has heard caregiver pagers going off at the front desk for nearly twenty minutes. Resident #2 (R2) interviewed at 10:20 a.m. on 11/01/23 stated staff have not always come quickly. Resident #3 (R3) interviewed at 2:15 p.m. on 11/01/23, stated staff took a long time to respond to call buttons. Interviews with Resident #4 (R4) at approximately 9:30 a.m. on 03/08/2024 and Resident #5 (R5) at approximately 11:00 a.m. on 03/08/2024 revealed they had to wait over an hour for their calls to be answered. Interview with Staff #2 (S2) at 11:30 a.m. on 11/01/23 revealed care givers respond as quick as they can, but due to short staffing, may take some time if caregivers and med techs are busy. Interview with Staff #3 (S3) at 3:00 p.m. on 11/01/2023 revealed if they were showering a resident, or if another caregiver was on break, there had often been only two caregivers per shift to tend to residents, and call button response times were delayed. Interviews with S4, S5, Staff #6 (S6) at 3:10 p.m. on 02/20/2024, and S7 revealed staff try to respond to requests within 10 – 15 minutes, but if staff need to tend to an emergency or paramedics, some call responses are delayed. Six (06) other staff members stated there were no issues with call response time and staff typically respond within 10 – 15 minutes of a call. During today’s facility tour, LPA observed S7 attend to several residents within a fifteen minute span. LPA tested the call button system of Room 219 at 9:55 a.m. S7 arrived at 10:07 a.m. to assist the resident. LPA tested the call button system of Room 206 at 3:27 p.m. today, and staff arrived at 3:29 p.m.

Based on interviews and observations, there are mixed accounts of how long staff take to respond to resident call system requests. Therefore, the allegation is deemed UNSUBSTANTIATED at this time and a note of Technical Assistance is issued pursuant to the California Code of Regulations (CCR) section 87468.2.

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: 03/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2