197610366-9-26-2024-31-AS-NMAN-DA6U9L-20241018152319

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610366
Report Date: 09/26/2024
Date Signed: 09/26/2024 04:56:42 PM

Substantiated

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
09/13/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20240913100027

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: 81	DATE:	09/26/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Marilou Mendoza		TIME COMPLETED:	04:55 PM

ALLEGATION(S):

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Facility staff did not ensure hallway was free of tripping hazard

INVESTIGATION FINDINGS:

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At approximately 10:00 a.m. on 09/26/24 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with the administrator and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit on 09/17/24 and interviewed three (03) residents, four (04) staff, and the administrator between 10:30 a.m. and 11:45 a.m. and toured the facility inside and out at 11:30 a.m. Today, LPA interviewed five (05) more residents and three (03) staff between 10:15 a.m. and 3:00 p.m., toured the facility inside and out at 10:50 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 2:30 p.m.

Regarding the allegation "Facility staff did not ensure hallway was free of tripping hazard" it was alleged a plastic tarp was laid down in the hallway which posed a tripping hazard to Resident #1 (R1).

Substantiated

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: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

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 5

Control Number 31-AS-20240913100027

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: 09/26/2024

NARRATIVE

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** This page was amended to include relevant information and correct a typo ** - LPA NR, 10/16/24

LPA received three (03) photographs on 09/16/24 of R1 using their walker on the plastic tarp in the hallway. The tarp was not taped down and was wrinkled, posing a tripping hazard to all residents. Record review of R1’s assessment from 12/06/22 revealed they were not a tripping hazard and did use a walker to ambulate. Interview with Staff #4 (S4) at 10:30 a.m. today revealed an outside vendor laid down the tarp in around June 2024 during kitchen repairs. Interviews with S4 and the Wellness Director at 2:30 p.m. today revealed the tarp was eventually taped down. The Wellness Director added that R1 is now nonambulatory and uses a walker. LPA did not observe any tripping hazards in the facility today or on 09/17/24. Based on observations, interviews, and record review, the plastic tarp posed a tripping hazard to R1, and the facility did not ensure the hallway was free of tripping hazards. Therefore, the allegation is deemed SUBSTANTIATED at this time. Deficiency is cited on the corresponding LIC 9099-D page.

Exit interview conducted. Appeal rights discussed. 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: 10/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Citations on this Visit Report are Under Appeal!

Control Number 31-AS-20240913100027

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Under Appeal Type B 10/07/2024 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents... and visitors. This requirement was not et as evidenced by:	1 2 3 4 5 6 7	Licensee has agreed to conduct an in-service training for all staff to maintain facility safety for all residents and employees. Training will be subitted by the POC due date.
	8 9 10 11 12 13 14	Based on observations, interviews, and record review, the licensee did not comply with the section cited above with the plastic tarp in the hallway, posing a potential Health, Safety, or Personal Rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 5

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
09/13/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20240913100027

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: 81	DATE:	09/26/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Marilou Mendoza		TIME COMPLETED:	04:55 PM

ALLEGATION(S):

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Facility staff are not preventing facility from being malodorous
Facility staff are not ensuring carpets are clean
Facility management staff are not available to resident's family

INVESTIGATION FINDINGS:

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At approximately 10:00 a.m. on 09/26/24 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with the administrator and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit on 09/17/24 and interviewed three (03) residents, four (04) staff, and the administrator between 10:30 a.m. and 11:45 a.m. and toured the facility inside and out at 11:30 a.m. Today, LPA interviewed five (05) more residents and three (03) staff between 10:15 a.m. and 4:00 p.m., toured the facility inside and out at 10:50 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 2:30 p.m.

Regarding the allegation "Facility staff are not preventing facility from being malodorous" it was alleged the main hallway “reeked of urine”.

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: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 31-AS-20240913100027

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: 09/26/2024

NARRATIVE

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During facility tours on 09/17/24 and today, LPA did not detect any foul odors in the facility. Interview with Staff #1 (S1) at 11:30 a.m. on 09/17/24 revealed they performed housekeeping duties in the facility. S1 cleans rooms and common areas everyday, and S1 has only smelled bad odors when residents are assisted with incontinence care. Interview with the administrator at 11:25 a.m. on 09/17/24 revealed they had not received any reports of foul odors in the facility. Interviews with six (06) other staff and eight (08) out of eight (08) residents interviewed revealed they have not detected foul odors in the facility. Based on observations and interviews, staff are ensuring the facility is not malodorous. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation "Facility staff are not ensuring carpets are clean” it was alleged the facility carpets were dirty. During facility tours on 09/17/24 and today, LPA observed the carpets to be aged but having so obvious signs of dirt which needed cleaning. Interview with S1 revealed carpets are cleaned everyday and shampooed twice a week. Interview with Staff #2 (S2) at 3:45 p.m. today confirmed the carpets are vacuumed everyday and shampooed as needed, though they did appear aged. Interview with the administrator revealed that carpets are cleaned everyday, and they had not received any reports of uncleanliness. Interviews with eight (08) out of eight (08) residents interviewed revealed they had no problems with the conditions of the facility carpets. Based on observations and interviews, staff are ensuring the carpets are clean. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation "Facility management staff are not available to resident's family" it was alleged no facility representatives from management were available for families. During facility tour on 09/17/24 LPA observed the licensing form LIC 308 Designation of Facility Responsibility posted at the reception area. It was signed on 08/07/24 and designated Wellness Coordinator Pamela Garrovillo as the manager in charge in the administrator’s absence. Interview with Pamela at 2:30 p.m. today confirmed she was in charge during the administrator’s absence. Interview with the administrator and Staff #3 (S3) at 11:15 a.m. on 09/17/24 revealed all staff were trained to report any family concerns to Pamela. Telephonic interview at 3:30 p.m. today with a family member of a resident revealed they were notified how to report concerns to in the administrator’s absence. Based on interviews and observations, although the administrator is not always present at the facility, the facility ensured a management representative was available to families and residents. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

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: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC9099 (FAS) - (06/04)

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