197610366-5-3-2023-31-AS-TAGD-CV6UTU-20230829155232

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610366
Report Date: 05/03/2023
Date Signed: 05/03/2023 02:15:40 PM

Unsubstantiated

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
04/25/2023 and conducted by Evaluator Tuesday Cabiness

COMPLAINT CONTROL NUMBER: 31-AS-20230425101627

FACILITY NAME:	SUMMIT ASSISTED LIVING OF TARZANA		FACILITY NUMBER:	197610366
ADMINISTRATOR:	NIRJARA ACHARYA		FACILITY TYPE:	740
ADDRESS:	5711 RESEDA BLVD		TELEPHONE:	(818) 996-2022
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	176	CENSUS: 33	DATE:	05/03/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Carmelita Roxas & Nirjara Acharya		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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1. Staff do not have snacks for the residents
2. Staff spoke inappropriately to resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst LPA (Tuesday Cabiness conducted an initial visit to investigate the allegations mentioned above. LPA met with Wellness Coordinator Carmelita Roxas and Executive Director Nirjara Acharya and informed them the reason of the visit. The following was determined:

Allegation #1: Staff do not have snacks for the residents. During today's visit, from 10am to 12pm, LPA conducted a physical plant inspection, interviewed staff and residents, and obtain facility documentation. Based on interviews and physical plant inspection, it was reported to LPA that snacks are available for residents upon request, and the facility is currently organizing a hydration station. LPA observed coffee, tea, and water. Fresh fruit and snacks will be eventually placed at the station. The facility recently hired a vendor to supply perishable and non-perishables; and LPA observed various forms of snacks for residents in the refrigerator and freezer. Residents reported to LPA, snacks are not always visibly available, but when requested, it is provided. Therefore, based on physical plant inspection, and interviews, the allegation is UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

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-20230425101627

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: SUMMIT ASSISTED LIVING OF TARZANA	FACILITY NUMBER: 197610366
	VISIT DATE: 05/03/2023

NARRATIVE

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Allegation # 2: Staff spoke inappropriately to resident in care. During today's visit, from 10am to 12pm, LPA interviewed staff and residents. Based on interviews, residents reported that staff are respectful and treat them with dignity and provide the best care to everyone. Although it was reported that resident #1 (R1) was spoken to inappropriately, R1 denied that claim, and reported that staff are kind and treat R1 with respect. Therefore, based on interviews, the allegation is UNSUBSTANTIATED at this time.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

LIC9099 (FAS) - (06/04)

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