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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610366
Report Date: 09/25/2024
Date Signed: 09/25/2024 05:54:48 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
09/17/2024 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20240917133201
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:
09/25/2024
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Marilou MendozaTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Staff did not ensure that resident was taken to medical appointments
INVESTIGATION FINDINGS:
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At approximately 10:10 a.m. on 09/25/24 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the Executive Director (ED) and disclosed the reason for the visit.

To investigate the allegations above, LPA interviewed staff and a resident between 10:15 a.m. and 12:00 p.m. today, today, toured the facility inside and out at 11:00 a.m., and conducted a record review of pertinent records, including but not limited to a medical assessment, care plan, and a face sheet at 11:15 a.m.

Regarding the allegation "Staff did not ensure that resident was taken to medical appointments" it was alleged that Resident #1 (R1) missed multiple medical appointments due to oversleeping and transportation issues. Interview with Staff #1 (S1) at 10:15 a.m. today revealed R1’s transportation has been arranged through their insurance.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
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-20240917133201
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: 09/25/2024
NARRATIVE
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The driver came to the front desk to wait for R1, and on several occasions, caregivers reported that R1 refused to go to their appointment. Interview with Staff #2 (S2) at 11:30 a.m. today confirmed that R1 told S2 directly that they did not want to go to their appointments. Interview with Staff #3 (S3) at 10:30 a.m. today revealed R1 refused multiple appointments due to back pain. LPA called R1 at 1:40 p.m. today. Interview with R1 revealed facility staff notified them of every appointment and transportation was available. R1 denied missing any appointments. Record review of R1’s medical assessment and care plan revealed R1 is able to communicate their needs and can perform all activities of daily living without assistance. Interview with R1’s transportation service at 12:15 p.m. today revealed they came to pick up R1 on all three (03) appointment dates they had missed, and R1 refused to attend the appointments. Based on interviews and record review, the facility ensured R1 was able to attend their medical appointments. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Copy of report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2