197610366-6-23-2023-31-AS-NMAN-CW8TFA-20231002144112

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610366
Report Date: 06/23/2023
Date Signed: 06/23/2023 12:22:41 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/21/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20230621163950

FACILITY NAME:	SUMMIT ASSISTED LIVING OF TARZANA		FACILITY NUMBER:	197610366
ADMINISTRATOR:	DAVID AGUINIGA		FACILITY TYPE:	740
ADDRESS:	5711 RESEDA BLVD		TELEPHONE:	(818) 996-2022
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	176	CENSUS:	DATE:	06/23/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:			TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Facility does not have hot water.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to the facility to investigate the above allegation. LPA met with the Executive Director, David Aguiniga, and explained the reason for the visit.

---Facility does not have hot water.

LPA conducted a physical plant tour at around 10:00 AM, requested documents at 11:00 AM interviewed staff and residents between 11:15 AM to 12:00 PM. During the physical plant tour, LPA observed hot water temperature that measured 109.8F. Record reviews revealed that the hot water issue was reported 06/21/2023, the issue was acknowledged by maintenance personnel and resolved the following day 06/22/2023. During interviews with staff, Staff #1 (S1) and Staff #2 (S2) stated that the issue was reported by residents, an on-duty maintenance worker attempted to fix them problem but could not and ordered replacement parts. (CONT. on LIC 9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

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

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230621163950

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUMMIT ASSISTED LIVING OF TARZANA	FACILITY NUMBER: 197610366
	VISIT DATE: 06/23/2023

NARRATIVE

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The parts were installed by maintenance the following day and the issue was resolved. During interviews with residents, all residents stated that there was no hot water 06/20/2023 but that the hot water came back within 48 hours. Based on interviews and record review, there is enough information to verify the allegation, therefore, the allegation is substantiated at this time. Although there was no hot water in the facility due to parts malfunction, the facility took the necessary steps in resolving the issue in a timely manner, therefore, a citation will not be issued at this time.

No health and safety issues noted during the visit.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

LIC9099 (FAS) - (06/04)

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