197610366-11-1-2023-31-AS-NMAN-D5HVRD-20240522163945

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610366
Report Date: 11/01/2023
Date Signed: 11/01/2023 05:10:58 PM

Unfounded

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
07/10/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20230710114855

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: 53	DATE:	11/01/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Jina Maleksarkissians		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff financially abused resident

INVESTIGATION FINDINGS:

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At 8:30 a.m. on 11/01/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with staff and disclosed the reason for the visit.

Regarding the allegation “Staff financially abused resident”, it was alleged Staff #1 (S1) stole personal checks from Resident #1 (R1) and Resident #2 (R2) between April 2022 and December 2022.
To investigate the allegation, LPA Cabiness gathered resident and facility documents, and interviewed staff and residents between 10:45 a.m. and 1:30 p.m. on 07/17/2023. LPA Reed conducted a file review at 4:00 p.m. on 10/27/2023 and interviewed staff today between 8:45 a.m. and 2:30 p.m.
Based on interviews and records reviewed, the timeframe of the allegation occurred prior to the operation of the current facility, Summit Assisted Living of Tarzana (197610366). The allegation occurred during the operation of the previous facility, Summit Assisted Living of Tarzana (197610186). Therefore, the allegation is false, could not have happened, and/or is without a reasonable basis and is deemed UNFOUNDED at this time. Exit interview conducted. Copy of report provided.

Unfounded

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: 11/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

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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