197610366-3-6-2024-31-AS-NMAN-D6LTFL-20240626144139

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610366
Report Date: 03/06/2024
Date Signed: 03/06/2024 05:02:53 PM

Substantiated

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
02/29/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20240229083546

FACILITY NAME:	SAVANT OF TARZANA		FACILITY NUMBER:	197610366
ADMINISTRATOR:	RITA MELDONIAN		FACILITY TYPE:	740
ADDRESS:	5711 RESEDA BLVD		TELEPHONE:	(818) 996-2022
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	176	CENSUS: 60	DATE:	03/06/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Rita Meldonian		TIME COMPLETED:	05:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not providing laundry service for residents.
Staff did not ensure elevator was not in disreair.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to this facility to investigate the above allegations. LPA met with Executive Director, Rita Meldonian, and explained the reason for the visit.

---Staff are not providing laundry service for residents.

It was alleged that laundry equipment was not working. To investigate the allegation, on 03/06/2024, physical plant tour at around 10:45 AM, and interviewed four (04) staff between 11:45 AM to 1:00 PM and interviewed thirteen (13) residents between 1:00 PM – 3:00 PM. During the physical plant tour, LPA observed that laundry machines were in working order and laundry services were being provided. During interviews with staff, all staff stated that there was an interruption in laundry services as the dryer was not working for three (03) days.

(CONT on LIC9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

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 4

Control Number 31-AS-20240229083546

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: SAVANT OF TARZANA	FACILITY NUMBER: 197610366
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/06/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/06/2024 Section Cited CCR 87307(a)(3)(F)	1 2 3 4 5 6 7	87307 Personal Accommodations & Services(a) Living accommodations...The following provisions shall apply:...(3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each	1 2 3 4 5 6 7	A plan of correction was not issued as the facility took the necessary measures to have the machine repaired and LPA observed all laundry machines in working order.
	8 9 10 11 12 13 14	resident...(F)Basic laundry service (washing, drying, and ironing of personal clothing). This requirement is not met as evidenced by; Based on interviews, facility dryer was in disrepair for three (03) days which poses a potential health, safety and personal rights risk to residents in care.	8 9 10 11 12 13 14
Request Denied Type B 03/12/2024 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by; Based on interviews and observations, one out of two elevators are not in working order which poses a potential health, safety and personal rights risk to residents in care.	1 2 3 4 5 6 7	Facility will notify the LPA by the POC due date what the plan is to repair the elevators, how residents will not be affected by this and provide an invoice indicating planned repair date.
	8 9 10 11 12 13 14	health, safety and personal rights risk to residents in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 31-AS-20240229083546

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: SAVANT OF TARZANA	FACILITY NUMBER: 197610366
	VISIT DATE: 03/06/2024

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

(This page of report was AMENDED to correct information regarding the number of elevators that were in disrepair).

During interviews with residents, all residents stated that there was an interruption in laundry services.

Based on interviews, there is enough information to verify the allegation. Therefore, the allegation is SUBSTANTIATED at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

--- Staff did not ensure elevator was not in disrepair.

It was alleged that elevators are broken. To investigate the allegation, on 03/06/2024, physical plant tour at around 10:45 AM, and interviewed four (04) staff between 11:45 AM to 1:00 PM and interviewed thirteen (13) residents between 1:00 PM – 3:00 PM. During the physical plant tour, LPA observed that one (01) out of two (02) elevators are not in working order. During interviews with staff, all staff stated that one (01) out of two (02) elevators are working, which is the elevator that goes from floor one (01) to floor two (02), and the other elevator that goes from floor one (01) to floor three (03) is not working. Staff #1 added that there is only one resident on the third floor, and they were offered rooms on levels where there is a working elevator, but that resident refused. During interviews with residents, all residents confirmed that there is an elevator in the facility that is not working.

Based on interviews, there is enough information to verify the allegation. Therefore, the allegation is SUBSTANTIATED at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

No other health and safety hazards were noted during the visit.
Exit interview was conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4