197609918-2-14-2023-31-AS-NMAN-CQBS55-20230327133347

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609918
Report Date: 02/14/2023
Date Signed: 02/14/2023 12:24:15 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/07/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20230207144052

FACILITY NAME:	TARZANA SENIOR LIVING INC		FACILITY NUMBER:	197609918
ADMINISTRATOR:	AYVAZYAN, SARGIS		FACILITY TYPE:	740
ADDRESS:	5236 OTIS AVE		TELEPHONE:	(747) 253-0007
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	6	CENSUS: 6	DATE:	02/14/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Khattoun Nikoyan		TIME COMPLETED:	12:25 PM

ALLEGATION(S):

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Resident's personal rights are being violated
Staff are not allowing visitors
Staff pushed resident

INVESTIGATION FINDINGS:

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At 9:15 a.m. on 02/14/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with Staff #1 (S1) and disclosed the reason for the visit. LPA toured the facility inside and out. No immediate health or safety concerns were observed. At 9:35 a.m. LPA called the Administrator and disclosed the reason for the visit. The Administrator stated S1 could sign licensing documents in his absence. From 10:00 a.m. to 11:20 a.m. LPA interviewed residents. From 11:20 a.m. to 11:45 a.m. LPA interviewed staff. At 10:20 a.m. LPA conducted a records review.

Regarding the allegation “Resident's personal rights are being violated”, it was alleged Resident #1 (R1) was not allowed to leave the facility and not allowed access to the house telephone. From interviews, staff stated outings and activities follow a schedule, and residents are not confined to the facility. Staff showed LPA the house phone which was located near the kitchen. Staff mentioned all residents had access to the phone. R1 stated they were allowed to leave the facility at any time, and they never had issues with telephone access.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

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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Control Number 31-AS-20230207144052

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TARZANA SENIOR LIVING INC	FACILITY NUMBER: 197609918
	VISIT DATE: 02/14/2023

NARRATIVE

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Other residents shared no concerns with phone access or being forced to remain inside the facility. Based on interviews, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff are not allowing visitors”, it was alleged R1 was not allowed any visitors since May of 2022. From interviews, R1 stated they had no issues receiving visitors at the facility. LPA interviewed Resident #2 (R2) and their family member who was visiting at the time. R2 stated they had visitors about once per month. Other residents interviewed expressed no concerns with visitation. Staff stated visitors are welcome during visiting hours. Based on interviews, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff pushed resident”, it was alleged a staff member pushed R1 in May of 2022. From interviews, R1 stated they were never pushed by staff. R1 and other residents said they never experienced abuse or rough handling from staff. Staff also confirmed they have never pushed any residents. Based on interviews, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

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

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

LIC9099 (FAS) - (06/04)

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