197610366-8-9-2024-31-AS-NMAN-D9WM6E-20241010091945

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610366
Report Date: 08/09/2024
Date Signed: 08/09/2024 04:06:56 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
07/17/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20240717142213

FACILITY NAME:	SAVANT OF TARZANA		FACILITY NUMBER:	197610366
ADMINISTRATOR:	RITA MELDONIAN		FACILITY TYPE:	740
ADDRESS:	5711 RESEDA BLVD		TELEPHONE:	(818) 996-2022
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	176	CENSUS: 78	DATE:	08/09/2024
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Rita Meldonian		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff are administering expired medication to a resident in care
Staff did not administer medication as prescribed

INVESTIGATION FINDINGS:

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At 2:30 p.m. on 08/09/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with the administrator and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit on 07/24/24 and toured the facility at 4:00 p.m. and interviewed Staff #1 (S1) at 4:10 p.m. and Staff #2 (S2) at 4:15 p.m. LPA interviewed Resident #1 (R1) over the phone at 10:15 a.m. on 07/25/24. Today, LPA toured the facility at 2:35 p.m., reviewed records pertinent to the investigation, including but not limited to a medical assessment, physician orders, and medication administration records (MARs) at 2:45 p.m., and interviewed Staff #3 (S3) at 3:00 p.m., Staff #4 (S4) at 3:15 p.m., and Staff #5 (S5) at 3:20 p.m.

Regarding the allegation “Staff are administering expired medication to a resident in care” it was alleged the facility provided outdated medications to R1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

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-20240717142213

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: 08/09/2024

NARRATIVE

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R1 clarified that no medications were actually expired. R1 stated they no longer needed ten (10) of their thirteen (13) medications and only wanted to take three (03) of them. LPA reviewed R1’s medications at 3:30 p.m. and saw no expired medications. Review of R1’s physician orders revealed R1 had fourteen (14) routine medications which were prescribed on 07/03/24 when R1 was admitted to the facility. Interview with S3 revealed that the physician prescribed all medications that R1 had at their previous facility. S3, S4, and S5 stated all physician orders are followed when assisting residents with medication and no expired medications are given. Based on interviews, record review, and medication review, the facility properly followed physician orders and did not administer expired medications. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff did not administer medication as prescribed” it was alleged the facility administered ten (10) additional, unnecessary medications, and that R1 did not receive their medications on 07/17/24. Interview with R1 revealed they believed they only need three (03) of their medications. Interview with S3 revealed R1 often refuses thyroid and seizure medication which they need. Review of R1’s MAR from July 2024 revealed R1 refused fourteen (14) out of fourteen (14) morning medications. Staff documented R1’s reason for refusing medication on 07/17/24 as “I’m not going to take my medications because it made me sick”. Staff documented refusals on other days as “I’m not depressed”, “I don’t have seizures”, and “I don’t have a thyroid problem”, and “I don’t want it”. S3, S4, and S5 confirmed R1 frequently refuses medications. Based on interviews and record review, the facility administered R1’s medications as prescribed. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety risks were observed during today’s visit.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

LIC9099 (FAS) - (06/04)

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