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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610366
Report Date: 08/16/2024
Date Signed: 08/16/2024 03:07:10 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
06/13/2024 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20240613141903
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: 78DATE:
08/16/2024
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Pam GarrovilloTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not meet residents' dietary needs
Staff do not ensure that the facility is maintained in good repair
Staff did not answer a resident's call button in a timely manner
INVESTIGATION FINDINGS:
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At approximately 2:15 p.m. on 08/16/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the administrator designee and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit on 06/21/24 and interviewed two (02) residents at 11:45 a.m. and 11:55 a.m., the administrator at 12:15 p.m., conducted a records review at 12:30 p.m. of documents pertinent to the investigation, including but not limited to an admission agreement, medical assessment, service plan, and physician orders, and toured the facility inside and out at 2:00 p.m. LPA conducted a subsequent visit on 07/12/24 and interviewed eight (08) out of seventy-five (75) residents, or 10% of the residents and two (02) staff members between 9:00 a.m. and 3:15 p.m. LPA conducted another subsequent visit on 07/16/24 and interviewed Staff #3 (S3) at approximately 9:30 a.m. and Staff #4 (S4) at 10:00 a.m. on 07/16/24 and toured the kitchen at 9:45 a.m.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
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-20240613141903
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: 08/16/2024
NARRATIVE
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Regarding the allegation “Staff do not ensure that the facility is maintained in good repair” it was alleged that for two (02) weeks the kitchen was out of order due to a gas problem. Interview with the administrator revealed that the issue pertained to the facility’s water line, not gas. Review of an incident report prior to the investigation revealed the facility discovered a maintenance issue with the water line on 06/03/24. The facility ordered maintenance from an outside vendor on 06/04/24 and notified Community Care Licensing on the same day. Interviews with the administrator, S3, and S4 revealed the kitchen had to be shut down for about two (02) weeks. LPA observed the water line in the kitchen had been dug up for maintenance. Based on record review and interviews, the facility appropriately addressed the maintenance issue in a timely manner. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.
Regarding the allegation “Staff did not meet residents' dietary needs” it was alleged that during the kitchen shut down, staff served residents cold cereal, cold meals and food ordered from outside sources which was not suitable for R1. Review of the incident report noted all residents were notified of the maintenance issue and all dinners would be catered in the meantime. The facility served snacks, non-perishable foods, and cold foods through their kitchen as usual. Record review of receipts of to-go orders confirmed the facility provided dinners in sufficient quantities. Interviews with the administrator, S3, and S4 revealed they heard residents enjoyed the catered meals. Interviews with eight (08) out of eight (08) residents revealed no residents had issues with the meals served during the water outage. Record review of R1’s medical assessment revealed they were on a “No Added Salt” diet. Interview with R1 at 10:05 a.m. on 07/12/24 revealed they enjoyed the meals and had no issue with the food in general. Based on interviews and record review, the facility met the residents’ dietary needs. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Staff did not answer a resident's call button in a timely manner” it was alleged staff did not assist R1 in putting on their compression socks. Interview with the administrator revealed the facility told R1 that they needed to first obtain a physician’s order for the compression sock as it was deemed a medical device. Interview with staff #1 (S1) at 2:30 p.m. on 07/12/24 revealed they called R1’s physician to obtain the order. Record review revealed that by 06/17/24 the facility had helped R1 obtain the order and began to assist R1 with the compression sock as prescribed by their doctor. Interview with R1 revealed they felt the staff were good and helpful. Interviews with Staff #2 (S2) at 11:30 a.m. on 07/12/24 and S1 revealed staff are prompt and responsive to resident call button requests. Based on record review and interviews, the facility attended to R1 in a timely and appropriate manner. 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: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2