<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610366
Report Date: 07/12/2024
Date Signed: 07/12/2024 04:45:18 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
06/28/2024 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20240628155820
FACILITY NAME:SAVANT OF TARZANAFACILITY NUMBER:
197610366
ADMINISTRATOR:RITA MELDONIANFACILITY TYPE:
740
ADDRESS:5711 RESEDA BLVDTELEPHONE:
(818) 996-2022
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY:176CENSUS: 75DATE:
07/12/2024
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Rita MeldonianTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not recognize resident's change in condition
Staff are not giving resident medication timely
Staff are not assisting resident with transportation to medical appointments
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At approximately 8:50 a.m. on 07/12/24, 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 07/02/24 and interviewed the ED at 12:15 pm., Staff #1 (S1) at 12:45 p.m., Staff #2 (S2) at 1:45 p.m., and Staff #3 (S3) at 2:15 p.m., toured the facility at 12:30 p.m., and conducted a records review at 1:30 p.m. of pertinent records including but not limited to incident reports, home health notes, Medication Administration Records (MARs), transportation schedules, and hospital documents. LPA interviewed Resident #1 (R1) at 12:15 p.m. on 07/11/24 and Staff #4 (S4) at 3:00 p.m. today.

Regarding the allegation “Staff did not recognize resident's change in condition” it was alleged the facility’s neglect may have been the reason for R1’s leg infection.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
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-20240628155820
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: 07/12/2024
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
R1 had a heart condition, cellulitis, and wound care. Interviews with S1, S2, and S3 revealed the facility was aware of R1’s infection and followed all physician orders and assisted with all medications to treat the infection. S1 stated R1 had venous Statis dermatitis, but R1 was noncompliant with wound care instructions and does not elevate their legs. S2 stated R1 would remove bandages after home health came to treat R1’s wounds. S3 said R1 would sit in a chair all day which did not allow the wounds to heal. S3 also stated that all antibiotic regimens were completed but were not effective. S1 confirmed that the oral antibiotics were ineffective, so the facility arranged for R1 to receive an intravenous (IV) antibiotic treatment on 06/19/24. Interview with R1 revealed they were fine with how the facility provided care for their infection. Record review of R1’s MAR revealed they received three (03) ten (10) day cycles of an antibiotic from 04/24/24 – 07/05/24. Wound care notes indicated “co-morbidities and ambulatory status may contribute to delayed wound healing” and that previous regiments were ineffective in treating R1’s infection. Based on interviews and record review, the facility provided sufficient care to support R1. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Staff are not giving resident medication timely” it was alleged R1 did not receive Tylenol until three (03) to four (04) hours after being requested. Interview with R1 revealed they had no issues with medication assistance and that S2 had explained to R1 that the facility could only provide one (01) dose of Tylenol every four (04) hours. S3 revealed that R1 was always provided with Tylenol when requested within the prescribed time frames. Record review revealed R1’s physician order for Tylenol stated “Take 1 tablet by mouth every 4 - 6 hours as needed for pain, max 6 tabs per day”. All entries in R1’s MAR were appropriately completed for each request. Based on interviews and record review, the facility assisted R1 with their medication in a timely manner. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Staff are not assisting resident with transportation to medical appointments” it was alleged the facility was too busy to transport R1 to a doctor’s appointment and also to the hospital for R1’s infection. Interview with the ED revealed the facility arranged for transportation for both of R1’s emergencies on 05/18/24 and 06/19/24. Record review of transportation logs revealed the facility shuttle transported R1 to appointments on 05/01/24, 06/14/24, and 07/03/24. Interview with R1 revealed their requests for transportation were either changed or denied multiple times by S4. Interview with S4 revealed some previous request for transportation were denied, however S4 and the ED offered to arrange for alternative transportation each time. Based on interviews and record review, the facility arranged for transportation for medical care for R1. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.
No immediate health and safety risks were observed during today’s visit. Exit interview conducted. Copy of report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2