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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610366
Report Date: 02/07/2025
Date Signed: 02/07/2025 04:29:09 PM

Document Has Been Signed on 02/07/2025 04:29 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:		RITA MELDONIANFACILITY TYPE:
740
ADDRESS:5711 RESEDA BLVDTELEPHONE:
(818) 996-2022
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY: 176CENSUS: 90DATE:
02/07/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Marilou MendozaTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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At 11:00 a.m. on 02/07/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced case management visit. LPA met with staff and later the administrator and disclosed the reason for the visit.

Today’s case management visit was conducted in conjunction with a complaint visit for complaint # 31-AS-20250205150035. During the course of investigation, a deficiency was discovered involving the facility’s Activity Director (AD). Interview with the AD at 11:05 a.m. today revealed they were sent to drive the facility van yesterday, 02/06/25, to ensure a resident attended their medical appointment. The driver that the facility recently hired, Staff #1 (S1), was busy with training and could not drive the van. Previous interviews with the AD on 12/21/2023 and 07/12/2024 revealed the AD has had to drive the facility van in previous instances. The AD also noted that they have filled in for front desk staff as needed. Interview with the administrator at 3:15 p.m. today confirmed that the AD had to drive the facility van yesterday when the designated driver was absent. The administrator confirmed that the AD has had to fill the role of the facility driver when no driver was available. When the AD drove the facility van, they were not fulfilling their full-time responsibility as an Activity Director. Therefore, a deficiency is issued on the corresponding LIC 809-D page.

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

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/07/2025 04:29 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Nicholas Reed On 02/07/2025 at 04:20 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: 02/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
02/17/2025
Section Cited
CCR
87219(f)

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87219 Planned Activities
(f) In facilities licensed for fifty (50) persons or more, one staff member shall have full-time responsibility to organize, conduct and evaluate planned activities
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The licensee has agreed to submit a plan in accordance to 87219(f)(1) to ensure residents are provided with activities and that the Activity Director fulfills their duties.
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Based on interviews and observations, the licensee did not comply with the section cited above through the Activity Director participating in other duties which poses a potential Health, Safety, or Personal Rights risk to residents 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.
SUPERVISOR'S NAME:Naira Margaryan
LICENSING EVALUATOR NAME:Nicholas Reed
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2025


LIC809 (FAS) - (06/04)
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