197610366-7-12-2024-31-AS-NMAN-D7GLUE-20240724090346

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610366
Report Date: 07/12/2024
Date Signed: 07/12/2024 04:43:41 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
12/05/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20231205151331

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: 75	DATE:	07/12/2024
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Rita Meldonian		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not meet a resident's showering needs while in care
Staff allow a resident to be soiled for an extended period of time
Staff did not meet a resident's incontinence need while in care
Staff did not allow a resident to have access to water
Staff leave a resident unattended on the toilet for an extended period of time

INVESTIGATION FINDINGS:

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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 12/13/2023 and toured the facility at 9:00 a.m., interviewed two (02) staff, the previous ED, and Resident #1 (R1) between 9:15 a.m. and 1:45 p.m., and reviewed records pertinent to the investigation, including but not limited to a physician’s report, admission agreement, shower schedule, Medication Administration Records (MARs), and face sheet. LPA conducted additional phone interviews between 1:45 p.m. and 3:00 p.m. on 03/06/2024 with three (03) staff and at 8:45 a.m. on 03/08/2024 with Staff #6 (S6). Today, LPA conducted another records review at 11:30 a.m. of records including but not limited to staff care notes and a service plan.

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: 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 3

Control Number 31-AS-20231205151331

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

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Regarding the allegation “Staff did not meet a resident's showering needs while in care” it was alleged R1 had not showered in twelve (12) days due to lack of assistance. Interview with R1 at 12:45 p.m. on 12/13/2023 revealed they had only showered six (06) times in two (02) months. R1 knew they had missed their scheduled shower time but liked to sleep until noon. Interview with the previous ED at 11:00 a.m. on 12/13/2023 revealed staff follow the facility’s shower schedule to coordinate shower times. The facility offers alternate times to residents if they miss their scheduled time. Although R1 originally chose 10 AM as their preferred shower time, R1 refused a shower on 12/12/2023 due to it being too early. LPA observed Staff #1 (S1) exiting R1’s room around 9:20 a.m. on 12/13/2023. Interview with S1 at 9:30 a.m. on 12/13/2023 confirmed R1 had refused their shower on 12/12/2023, so S1 offered to shower R1 on 12/13/2023. R1 refused the shower the again. S1 further stated other residents also refuse showers occasionally. Record review of the facility shower schedule confirmed R1 was scheduled for showers 10:00 a.m. on Tuesdays and Fridays. Review of shift notes from 12/15/2023 revealed R1 refused their shower. Based on interviews and record review, the facility offered shower services to R1 which were occasionally refused. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff allow a resident to be soiled for an extended period of time” it was alleged R1 remained in soiled diapers throughout the night when staff did not check on them. Interview with R1 revealed they had experienced consecutive days in which they were changed at 10:00 p.m. then changed again at 9:30 a.m. the following day. R1 stated S6 was the only staff to change them more than once during the night. Interview with S6 confirmed they changed R1 throughout the night at 1:00 a.m. and 5:00 a.m., and R1 “kissed their hand”. Interview with S1 revealed they change R1 “about twice a night” and S1 if often sleeping at night and does not wat to be bothered. Interview with Staff #3 (S3) at 2:50 p.m. on 03/06/2024 and Staff #4 (S4) at 3:00 p.m. on 03/06/2024 revealed they changed R1’s diaper as needed and checked on them every two (02) hours. Record review of shift notes from 12/07/2023 revealed R1 “refused to be changed if [they are] sleeping but we still check on her”. Shift notes from 12/20/2023 indicated R1 again refused to be changed due to sleeping. Based on interviews and record review, the facility provided proper supervision and incontinence assistance to R1. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (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

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20231205151331

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

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Regarding the allegation “Staff did not meet a resident's incontinence need while in care” it was alleged R1 developed a Urinary Tract Infection (UTI) due to lack of incontinence care. Interview with R1 revealed it burned when they urinated around the end of November 2023. They reported the pain to staff and were diagnosed with a UTI. R1 took a week of antibiotics and cranberry pills to cure it. Record review of R1’s MAR revealed the facility followed physician orders and assisted with all antibiotics from 11/30/23 – 12/07/23 and cranberry pills from 11/28/23 – 12/11/23. Review of R1’s service plan revealed that as of 11/10/2023, R1 had not had a UTI within the past thirty (30) days. Also, R1 was “occasionally incontinent” for bladder and bowels. Interview with Staff #2 (S2) at 9:45 a.m. on 12/13/2023 revealed the R1’s UTI was likely caused by refusals to be changed at night. S2 added that the facility staff check on R1 and attempt to change them to prevent UTIs but respect R1’s right to refuse. No other records revealed relevant information about R1’s UTI. Based on interviews and record review, there is no indication of a lack of care and supervision by the facility. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.
Regarding the allegation “Staff did not allow a resident to have access to water” it was alleged staff did not provide water to R1 at night. Interview with R1 revealed Staff #5 (S5) was too busy to assist R1 and only provided “a little sip” of water, though it was not a big problem for R1. Interview with S5 at 1:45 p.m. on 03/06/2024 revealed they provide adequate care and water to R1, and R1 is accustomed to a higher level of care from a different type of facility. Interviews with S1, S3, and the previous ED confirmed that R1 always has water available to them. Interviews with S2 revealed that R1 preferred to have three (03) cups of water, not just one (01). Based on interviews, the facility provided R1 with access to water. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.
Regarding the allegation “Staff leave a resident unattended on the toilet for an extended period of time” it was alleged R1 was left on the toilet longer than preferred. Interview with R1 revealed staff are busy, but toileting is not a big problem. R1 prefers more consistency. Interview with five (05) out of six (06) staff revealed no relevant information about being left on the toilet, and staff assisted R1 as necessary. Record review of R1’s preplacement appraisal from 10/20/2023 revealed the facility would assist with transferring to and from the toilet. Interview with S5 revealed they assisted R1 with toileting and never left them on the toilet for long periods of time. Interview with the ED at 3:00 p.m. on 07/02/2024 revealed R1 used diapers during the nighttime and used the toilet during daylight hours. No issues were reported regarding R1’s toileting. Based on observations and record review, staff did not leave R1 unattended for long periods of time. 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.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (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

LIC9099 (FAS) - (06/04)

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