<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610366
Report Date: 08/15/2025
Date Signed: 08/15/2025 05:05:56 PM

Document Has Been Signed on 08/15/2025 05:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 TARZANAFACILITY NUMBER:
197610366
ADMINISTRATOR/
DIRECTOR:		NARINE MERTKHANYANFACILITY TYPE:
740
ADDRESS:5711 RESEDA BLVDTELEPHONE:
(818) 996-2022
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY: 176CENSUS: 100DATE:
08/15/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Narine MertkhanyanTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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
At approximately 8:45 a.m. on 08/15/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced case management visit. LPA met with staff and disclosed the reason for the visit.

Today’s case management visit was conducted after reviewing two (02) incident reports submitted by the facility in which Resident #1 (R1) was admitted to Sherman Oaks Hospital around 10:00 a.m. on 08/02/25 with hip pain and later found unresponsive on the street near Providence-Tarzana Hospital around 2:00 p.m. on the same day.

LPA conducted a record review of pertinent documents, including but not limited to R1’s discharge paperwork and face sheet around 9:40 a.m. on 08/14/25 and interviewed Staff #1 (S1) at approximately 9:50 a.m. on 08/14/25. Interview with S1 confirmed R1 was admitted to the hospital during the morning of 08/02/25 for hip pain. R1 was discharged that same day and returned to the facility. S1 later received a phone call from Providence-Tarzana Hospital noting R1 was found unresponsive near the hospital around 2:00 pm.. Record review indicated that R1 was admitted to the Emergency Room at Sherman Oaks Hospital at 11:16 a.m. on 08/02/25 for hip pain, nausea, vomiting, and opioid withdrawal. Discharge paperwork from Providence- Tarzana Hospital indicated that R1 was admitted for an accidental overdose and diagnosed with an altered mental status and opioid dependence on 08/02/25. Review of R1’s face sheet from 07/31/25 revealed they were already diagnosed with opioid dependence prior to these hospitalizations.

Today, LPA obtained a resident list around 9:00 a.m. which indicated that R1 was in the hospital. LPA called the hospital around 11:45 a.m. this morning to speak with R1. A nurse in the Intensive Care Unit responded and explained that R1 was admitted yesterday, 08/14/25, for their second overdose in two (02) weeks. Interview with Staff #2 (S2) at approximately 2:00 p.m. today revealed that the home health nurse for R1's

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Nicholas Reed
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 08/15/2025
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
roommate reported that they discovered R1 unresponsive in their room around 8:30 a.m. on 08/14/25. The nurse also told S2 that R1 had drugs. Staff called 9-1-1, and S2 performed CPR until paramedics arrived.

Review of R1’s plan of care at approximately 2:05 p.m. today revealed staff were to supervise R1 once per shift, or about every eight (08) hours. LPA reviewed a reappraisal from 08/03/25 noted the facility would "continue with wellness check" but did not reference increased supervision.

LPA previously addressed the facility’s approach towards residents with substance abuse issues during a case management visit on 03/05/25. Interview with S1 at 12:15 p.m. on 03/05/25 revealed staff were aware of multiple residents drinking alcohol in the facility and staff have not received training on providing care and supervision to residents with substance abuse problems. Interview with the previous administrator at 1:30 p.m. on 03/05/25 revealed the facility could issue a training for all staff on dealing with substance abuse issues as well as updating the facility program plan to address care of residents with substance abuse issues.

Based on interviews and record review, the facility did not create an adequate care plan update or reappraisal to address R1's opioid dependence and subsequent overdoses on 08/02/25 and 08/14/25. R1's documents did not address their needs, so staff were unable to prevent R1's second overdose on 08/14/25. Therefore a deficiency is issued today for an inadequate care plan update to address R1's needs and to ensure the facility could provide proper care and supervision for R1. A $500 immediate civil penalty is assessed today for a violation resulting in the overdose of R1. The licensee/administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f).

No immediate health or safety concerns were observed during today's visit.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Nicholas Reed
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/15/2025 05:05 PM - It Cannot Be Edited


Created By: Nicholas Reed On 08/15/2025 at 02:59 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SAVANT OF TARZANA
FACILITY NUMBER: 197610366

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
08/18/2025
Section Cited
CCR
87466

1
2
3
4
5
6
7
87466 Observation of the Resident
The licensee shall ensure that residents are regularly observed for changes... and that appropriate assistance is provided when such observation reveals unmet needs. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee conducted an in-service training on the cited section and submitted proof during the visit. Deficiency cleared.
8
9
10
11
12
13
14
Based on interviews and record review, the licensee did not comply with the section cited above by not providing adequate care to Resident #1 (R1) to address their substance use issue which posed an immediate risk to the Health, Safety, or Personal Rights of persons 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.
Naira Margaryan
NAME OF LICENSING PROGRAM MANAGER:
Nicholas Reed
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2025


LIC809 (FAS) - (06/04)
Page: 4 of 4