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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610366
Report Date: 07/12/2024
Date Signed: 07/12/2024 04:45:47 PM


Document Has Been Signed on 07/12/2024 04:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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 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
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Rita MeldonianTIME COMPLETED:
04:30 PM
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At approximately 8:50 a.m. on 07/12/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced case management visit. LPA met with staff and later the Executive Director (ED) and disclosed the reason for the visit.

Today’s case management visit is conducted in conjunction with Complaint # 31-AS-20240628155820. During the course of investigation, LPA interviewed several residents with facility concerns which were unrelated to the investigation. LPA interviewed Resident #1 (R1) at 9:00 a.m. today, Resident #2 (R2) at 9:10 a.m., Resident #3 (R3) at 9:30 a.m., Resident #4 (R4) at 9:45 a.m., Resident #5 (R5) at 10:00 a.m., Resident #6 (R6) at 10:05 a.m., Resident #7 (R7) at 10:20 a.m., Resident #8 (R8) at approximately 2:30 p.m., Resident #9 (R9) at 3:15 p.m., and the ED at 2:45 p.m. LPA conducted a records review of physician reports at 3:00 p.m. today. Interview with R1 revealed they had mold growing in their bathroom. LPA inspected R1’s room at approximately 10:45 a.m. and noticed a discoloration on the ceiling. Interview with the ED noted the facility was aware of the discoloration caused by a leak above the room and had taken action to fix the leak. Interview with R2 revealed R9 had been attacked approximately three (03) days prior by an unknown individual on the street. Interview with R9 revealed they were unharmed with no lasting injuries. The ED discussed the incident with LPA and provided an SOC341 form. Interview with R3 revealed they had been bitten by their roommate, R8 approximately two (02) days ago. R8 did not recall the event. The ED stated nothing had been reported to them, but they would investigate further. Interview with R4 revealed they were forced to sign a document. The ED noted R4 was requested to sign a document which stated they wished to leave the facility but never forced. Interview with R5 and R6 revealed they had an odor of mold or mildew in their bathroom from a leak. The ED stated the leak and the mold issue had already been resolved over one (01) week ago.

During today's inspection, the facility was in compliance with Title 22 regulations. No deficiencies were observed, but LPA will return on a future date to further investigate the incident between R3 and R8 and the alleged mold in the bathrooms of R1, R6, and R7. Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
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.

LIC809 (FAS) - (06/04)
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