197610366-1-26-2024-31-AS-NMAN-D26NW9-20240205094907

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610366
Report Date: 01/26/2024
Date Signed: 01/26/2024 04:17:03 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
01/24/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20240124132851

FACILITY NAME:	SAVANT OF TARZANA		FACILITY NUMBER:	197610366
ADMINISTRATOR:	JINA MALEKSARKISSIANS		FACILITY TYPE:	740
ADDRESS:	5711 RESEDA BLVD		TELEPHONE:	(818) 996-2022
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	176	CENSUS: 56	DATE:	01/26/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Rita Meldonian		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Facility did not adhere resident’s request

INVESTIGATION FINDINGS:

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At 10:45 a.m. on 01/26/2024, 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.

Regarding the allegation “Facility did not adhere resident’s request” it was alleged the facility would not remove the name plate outside of the room of Resident #1 (R1). To investigate the allegation, LPA toured the facility at 11:00 a.m. today, interviewed the ED at 11:30 a.m., Resident #1 (R1) at 11:45 a.m., Staff #1 (S1) at 12:00 p.m., Staff #2 (S2) at 12:15 p.m., and five (05) other residents between 12:30 and 1:15 p.m., and reviewed pertinent records at 1:30 p.m.\ including but not limited to the resident list, a physician’s report, admission agreement, care plan, and the plan of operations. LPA also interviewed the former ED at 11:30 a.m. on 12/21/2023.

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: 01/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

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-20240124132851

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: 01/26/2024

NARRATIVE

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Interview with R1 revealed they wanted their name plate removed if none of the other residents on their floor had name plates. They did not want to be the only resident with a name plate. R1 stated it was “not so much of a safety concern”. The facility tour revealed that seven (07) out of eleven (11) rooms in R1’s hallway had name plates in front of their doors. Three (03) of the eleven (11) rooms were unoccupied and did not have name plates. Interview with the former ED revealed the name plates were present for emergency evacuation procedures. The current ED stated the name plates help to identify residents so staff can correctly assist with medication. S1 and S2 had not heard of any safety or privacy concerns from R1. Five (05) out of five (05) other residents interviewed had no safety or privacy concerns with the name plates. Based on interviews and observations, the facility identifies resident rooms to assist with proper medication assistance, and R1 will allow the name plate to remain if other residents have name plates as well. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety hazards were observed during this visit.

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: 01/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

LIC9099 (FAS) - (06/04)

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