197610366-1-9-2025-31-AS-NMAN-DHTTZC-20250620151006

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610366
Report Date: 01/09/2025
Date Signed: 01/09/2025 05:43:18 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
01/02/2025 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20250102110330

FACILITY NAME:	SAVANT OF TARZANA		FACILITY NUMBER:	197610366
ADMINISTRATOR:	RITA MELDONIAN		FACILITY TYPE:	740
ADDRESS:	5711 RESEDA BLVD		TELEPHONE:	(818) 996-2022
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	176	CENSUS: 89	DATE:	01/09/2025
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Carmelita Roxas		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff left resident in soiled bedding for an extended period of time
Staff did not ensure resident was showered

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

At 10:20 a.m. on 01/09/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and disclosed the reason for the visit.

To investigate the allegations above, LPA interviewed staff and ten percent (10%) of residents, or ten (10) out of 90 residents between 10:30 a.m. and 1:00 p.m. today, toured the facility inside and out at 10:45 a.m., and conducted a record review of pertinent records, including but not limited to a medical assessment, care plan, and staff and client rosters at 11:15 a.m.

Regarding the allegation "Staff left resident in soiled bedding for an extended period of time" it was alleged the colostomy bag of Resident #1 (R1) popped and they were left covered in feces throughout the night. It was also alleged that R1 requested assistance and no staff helped them. Interview with Staff #1 (S1) at 10:45 a.m. today revealed that they were aware R1’s colostomy bag popped and sent staff to

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

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-20250102110330

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: 01/09/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

assist. Interview with Staff #2 (S2) at 11:00 a.m. today revealed that they and Staff #3 (S3) assisted R1 within 30 minutes of the incident. Interview with S3 at 11:15 a.m. confirmed that both S2 and S3 assisted R1 within 30 minutes after their colostomy bag popped. Interview with Resident #2 (R2) at 12:50 p.m. today revealed they witnessed staff assist R1 with their colostomy bag issue about 30 minutes after it had popped. Record review of R1’s preassessment revealed they were able to manage their own toileting needs. Interview with R1 at 10:30 a.m. today confirmed that they are able to and prefer to manage their colostomy care on their own. Based on interviews and record review, staff assisted R1 in a timely manner. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff did not ensure resident was showered” it was alleged staff did not shower R1 until the following morning after their colostomy bag popped. Interview with S2 revealed they were ready to shower R1 immediately, but they went to smoke a cigarette instead. S2 had to wait about 30 minutes prior to helping R1 shower. Interview with S3 confirmed that R1 went to smoke prior to receiving shower assistance. Interview with R2 confirmed that staff assisted R1 in showering approximately 30 minutes after their colostomy bag popped. Based on interviews, staff provided shower assistance to R1 in a timely manner. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health or safety concerns 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: 01/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2