197610366-3-13-2024-31-AS-NMAN-D5SVJW-20240531162924

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610366
Report Date: 03/13/2024
Date Signed: 03/13/2024 03:55:23 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
02/15/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20240215090447

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: 60	DATE:	03/13/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Rita Meldonian		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not respond to resident's call for assistance
Staff do not provide daily activities for residents in care

INVESTIGATION FINDINGS:

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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.

To investigate the allegations above, LPA conducted an initial visit on 02/20/2024 and toured the facility at 2:00 p.m., interviewed three (03) out of fifty-three (53) residents between 2:00 p.m. and 3:00 p.m., and interviewed four (04) staff between 3:00 p.m. and 3:30 p.m. LPA conducted a subsequent visit on 03/08/2024 and interviewed seven (07) out of fifty-nine (59) residents, which was 10% of residents, four (04) staff members between 8:45 a.m. and 1:00 p.m., and toured the facility at 11:00 a.m. Today, LPA interviewed three (03) staff members and the ED between 9:00 a.m. and 10:45 a.m., conducted a records review at 9:45 a.m. of pertinent files including but not limited to an admission agreement, activity schedule, activity calendar, medical assessment, and physician’s orders, and toured the facility at 9:30 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: 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)

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Control Number 31-AS-20240215090447

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: 03/13/2024

NARRATIVE

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Regarding the allegation “Staff did not respond to resident's call for assistance” it was alleged that staff did not respond when Resident #1 (R1) used the call system on 02/14/2024 for assistance with a blood pressure reading. Interview with the ED at 10:45 a.m. today revealed R1 called for assistance approximately four (04) to six (06) times each day and demanded assistance from a med tech specifically. The ED explained to R1 that staff will reasonably address their concerns. Interview with Staff #1 (S1) at 3:00 p.m. on 02/20/2024 revealed R1 was independent and could record their own blood pressure. Interview with Staff #3 (S3) at 3:30 p.m. on 02/20/2024 revealed staff respond to all call button requests of residents in a timely manner, regardless of their needs. S3 confirmed that R1 uses the call button very frequently. Record review of R1’s medical assessment revealed they had a full capacity for self-care including bathing, grooming, dressing, toileting, and managing cash resources and medications. LPA tested the call button system of Room 219 at 9:55 a.m. Staff #5 (S5) arrived at 10:07 a.m. to assist the resident. LPA tested the call button system again at 3:27 p.m. today, and staff arrived at 3:29 p.m. Based on interviews, record review, and observations, staff respond to resident calls for assistance. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff do not provide daily activities for residents in care” it was alleged the facility does not provide physical activities for residents. Interviews with Staff #2 (S2) at 3:10 p.m. and Staff #3 (S3) at 3:30 p.m. on 02/20/2024 revealed the facility did not offer activities when the Activities Director (AD) had to drive residents. Interview with S4 revealed that today’s morning exercise would not occur because the AD had to drive Resident #2 (R2) to a medical appointment around 10:00 a.m. and would not be able to lead the morning exercise. At approximately 10:30 a.m., LPA observed staff assisting residents to attend morning exercise. S4 then stated that R2’s appointment and the morning exercise had been rescheduled. Interview with the AD at 10:05 a.m. on 03/08/2024 revealed they are also the facility driver and activities are always provided for residents. Sometimes few or no residents attend so it may seem like no activities are occurring. Interview with the ED and the AD revealed the facility will be hiring a full time driver by 03/18/2024. Record review of the facility’s plan of operations revealed “physical activities such as games, sports, and exercise” are “planned throughout each month”. Review of the March activity calendar revealed “Morning Exercise” was scheduled at 9:30 a.m. today. During the facility tour, LPA observed puzzles, books, and board games throughout the facility as well as a posting for “Flex, Stretch, Move” Mondays through Fridays at 9:30 a.m. Based on interviews, record review, and observations, physical activities were provided to residents but outside of the scheduled time. Therefore, the allegation is deemed UNSUBSTANTIATED at this time and a note of Technical Assistance is issued to ensure residents are provided activities each day pursuant to California Code of Regulations (CCR) section 87219.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)

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