197610366-1-26-2024-31-AS-NMAN-D5SVQE-20240531163812

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610366
Report Date: 01/26/2024
Date Signed: 01/26/2024 04:18:02 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
12/20/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20231220151703

FACILITY NAME:	SAVANT OF TARZANA		FACILITY NUMBER:	197610366
ADMINISTRATOR:	JINA MALEKSARKISSIANS		FACILITY TYPE:	740
ADDRESS:	5711 RESEDA BLVD		TELEPHONE:	(818) 996-2022
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	176	CENSUS: 56	DATE:	01/26/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Rita Meldonian		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff handled resident in a rough manner
Staff did not treat resident with dignity and respect

INVESTIGATION FINDINGS:

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

At 10:45 a.m. on 01/26/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with the Executive Director (ED) and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit at 11:15 a.m. on 12/21/23 and toured the physical plant at 11:15 a.m., interviewed the previous ED at 11:30 a.m., Staff #2 (S2) at 12:00 p.m., Staff #3 (S3) at 12:30 p.m., and Staff #4 (S4) at 1:00 p.m., and reviewed records at 1:30 p.m. including but not limited to a face sheet, physician’s report, care plan, daily notes, appraisal, and admission agreement. Today, LPA interviewed Resident #1 (R1) at 12:30 p.m. and Staff #1 (S1) at 1:45 p.m and toured the facility at 11:00 a.m.

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: 01/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

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-20231220151703

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: SAVANT OF TARZANA	FACILITY NUMBER: 197610366
	VISIT DATE: 01/26/2024

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

Regarding the allegation “Staff handled resident in a rough manner” it was alleged S1 put their arm around the neck of R1 and tried to pull R1 from the facility van. Interview with R1 revealed S4 was the driver and told S1 to 'jerk' R1 from the van. S1 wrapped their arm around R1's neck three (03) times, and R1 had to push S1 away. S2 and S3 came moments later to diffuse the situation. Interview with S1 revealed they touched R1 at the shoulder and waist and never put their arm around R1’s neck. Interviews with S2, S3, and S4 revealed S1 never had their arm around R1’s neck. S2 and S4 stated S1 let go of R1 immediately when R1 yelled out. Based on interviews, S1 did not handle R1 in a rough manner. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff did not treat resident with dignity and respect” it was alleged S4 became upset with R1 and refused to drive R1 to their destination. Interview with S4 revealed R1 had forgotten the address of the destination and therefore S4 did not know where to go. S3 confirmed this has happened before, and S2 stated R1 was suffering from an episode of confusion. S2 and S4 stated R1 grew agitated and yelled at S4 and called S4 a name. R1 confirmed they raised their voice and called S4 a name. The facility agreed to reschedule the ride to another date when R1 could present the correct address. S4 denied becoming upset or rude with R1. R1 stated they were taken to their destination at a later date. Based on interviews, the facility could not drive R1 to an unknown destination and properly rescheduled the appointment. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety hazards 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: 01/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2