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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610366
Report Date: 05/01/2025
Date Signed: 05/01/2025 11:01:06 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
03/17/2025 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20250317141735
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: 91DATE:
05/01/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Narine MertkhanyanTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Facility does not allow residents to chose their 3rd party health care providers
INVESTIGATION FINDINGS:
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At approximately 9:30 a.m. on 05/01/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit in conjunction with an annual inspection. LPA met with the administrator and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit on 03/18/25 and interviewed staff and residents between 10:15 a.m. and 4:15 p.m., toured the facility at 10:40 a.m., and conducted a record review of pertinent records, including but not limited to home health records, hospice records, and staff and client rosters at 1:45 p.m. LPA conducted telephonic interviews with Visitor #1 (V1) at 1:00 p.m. on 03/18/25, Visitor #2 (V2) at 11:00 a.m. on 03/25/25, and Visitor #3 (V3) at 4:45 p.m. on 03/28/25.

Regarding the allegation "Facility does not allow residents to choose their 3rd party health care providers" it was alleged multiple residents were enrolled into home health and hospice services without alternative choices provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
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 5
Control Number 31-AS-20250317141735
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: 05/01/2025
NARRATIVE
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 At approximately 11:00 a.m. on 03/18/25, LPA reviewed a list of residents receiving home health and hospice services. Interview with Staff #3 (S3) at approximately 11:15 a.m. on 03/18/25 and Staff #4 (S4) at approximately 11:20 a.m. on 03/18/25 revealed the facility usually offers residents three (03) options when deciding between home health or hospice agencies. S3 also noted that six (06) residents were assigned a new home health agency, Skilled Home Heath, Inc., on approximately 03/04/25. Record review of consent forms revealed all six (06) residents signed admission consent forms with Visitor #4 (V4) who was an employee of Skilled Home Health, Inc. Telephonic interview with V4 at approximately 9:30 a.m. on 03/19/25 revealed they were directed by their boss at Skilled Home Health, Inc. to enroll the six (06) residents into home health services. Telephonic interview with a representative from Skilled Home Health, Inc. (V5) at approximately 3:00 p.m. on 03/18/25 revealed all six (06) residents were prescribed physician’s orders for the home health services. Interviews with five (05) out of the six (06) residents enrolled into Skilled Home Health, Inc. around 03/04/25 revealed they did not remember signing consent forms and did not recall receiving different choices for home health agencies. Interview with Resident #1 (R1) at approximately 2:20 p.m. on 03/18/25 revealed a representative from a different home health agency solicited services to R1 around February 2025. R1 stated that a facility employee later told R1 “we are going to use our own healthcare” when referencing R1's enrollment into Skilled Home Health, Inc. Interview with V1, who was a representative of Resident #7 (R7), revealed they received a phone call from facility staff telling them that they were going to enroll R7 into hospice services. Interview with V2, who was a representative of Resident #8 (R8) revealed facility staff suggested hospice for R8 and that a hospice agency would reach out to them. Both V1 and V2 stated they were not provided options of hospice agencies to choose. Record review of the facility’s admission agreement at 2:30 p.m. today revealed that residents “may utilize home health agencies, or other providers of [their] choice”. Based on interviews and record review, R7 and R8 enrolled into hospice services without them or their representatives being offered choices of hospice agencies. Out of the six (06) residents enrolled into Skilled Home Health, Inc. around 03/04/25, only R1 was provided a choice of home health agencies. R1 was later told they would be enrolled into Skilled Home Health, Inc. Therefore, the allegation is deemed SUBSTANTIATED at this time. Deficiency is cited on LIC 9099-D page.

No immediate health and safety concerns 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: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Citations on this Visit Report are Under Appeal!

Control Number 31-AS-20250317141735
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: 05/01/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
05/12/2025
Section Cited
CCR
87468.2(a)(18)
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87468.2 Additional Personal Rights... (a) …residents… shall have all of the following personal rights: (18) To select their own... hospice agency, and health care providers in a manner that is consistent with the resident’s admission agreement.This requirement was not met as evidenced by:
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Licensee has agreed to conduct an in-service training on the cited section and submit proof of correction by the POC due date.
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Based on interviews and record review, the licensee did not comply with the section cited above in at least (08) out of ninety-one (91) residents' rights to choose their own health services which posed a potential Health, Safety, or Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
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
03/17/2025 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20250317141735

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: 91DATE:
05/01/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Narine MertkhanyanTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
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9
Facility staff insufficient to meet resident needs
INVESTIGATION FINDINGS:
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At approximately 9:30 a.m. on 05/01/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit in conjunction with an annual inspection. LPA met with the administrator and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit on 03/18/25 and interviewed staff and residents between 10:15 a.m. and 4:15 p.m., toured the facility at 10:40 a.m., and conducted a record review of pertinent records, including but not limited to home health records, hospice records, and staff and client rosters at 1:45 p.m. LPA conducted telephonic interviews with Visitor #1 (V1) at 1:00 p.m. on 03/18/25, Visitor #2 (V2) at 11:00 a.m. on 03/25/25, and Visitor #3 (V3) at 4:45 p.m. on 03/28/25.

Regarding the allegation "Facility staff insufficient to meet resident needs" it was alleged there are insufficient staff to meet all residents’ care needs. At approximately 11:00 a.m. on 03/18/25, LPA reviewed the daily staff duties list with the administrator and Wellness Coordinators.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
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-20250317141735
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: 05/01/2025
NARRATIVE
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Staff duties for the morning and afternoon of 03/18/25 were divided amongst three (03) caregivers. Each caregiver was assigned to provide care for approximately twenty-one (21) residents with needs such as escorting to and from meals, incontinence care, shower assistance, and assistance with other activities of daily living. It was estimated that each caregiver was assigned approximately six (06) hours of work for morning and afternoon shifts. LPA, Administrator, and Wellness Coordinators also reviewed the overnight shift assignments, in which two (02) caregivers were assigned to provide incontinence care and supervision for twenty-eight (28) residents. It was estimated that each caregiver was assigned approximately five (05) hours of work for overnight shifts. Interviews with the three (03) morning caregivers revealed that all caregivers had sufficient time to complete all necessary tasks. Interview with Staff #1 (S1) at 1:55 p.m. on 03/18/25 revealed that they do get short staffed at times when a caregiver calls out sick. Interview with Staff #2 (S2) at 2:05 p.m. on 03/18/25 revealed that they assist other caregivers to complete duties. Interviews with nine (09) out of eighty-nine (89) residents, which was at least 10% of the census, revealed that their care needs are met by staff. Based on record review and interviews, the facility is sufficiently staff to meet the needs of the residents. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety concerns 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: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5