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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610366
Report Date: 05/01/2025
Date Signed: 05/01/2025 11:04:16 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/01/2025 11:04 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: 91DATE:
05/01/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Narine MertkhanyanTIME VISIT/
INSPECTION COMPLETED:
05:30 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 10:30 a.m. on 04/30/25, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with the administrator and Vice President of Operations (VP) and disclosed the reason for the visit. The Regional Director of Operations later joined the visit at approximately 1:00 p.m. Due to time constraints, LPA returned to the facility today at approximately 9:30 a.m. and finished the inspection with the administrator and VP.

A file review was conducted prior to the visit.

The facility was last visited on 03/18/25 for a complaint visit. It is a three (03) story building with a capacity of 176 residents. LPA observed bedrooms, shared and private bathrooms, kitchen and dining areas, garage, common areas, activity rooms, offices, and a courtyard. It has an approved fire clearance for 176 nonambulatory residents, of which fifty (50) may be bedridden. Approved hospice waivers for thirty (30).

Between 10:30 a.m. and 3:30 p.m. on 04/30/25 and between 9:30 a.m. and 11:00 a.m. today, LPA, administrator, and VP toured the facility. At approximately 10:00 a.m. on 04/30/25 the facility telephone was called and deemed operational. At 1:30 p.m. on 04/30/25, a medication review was conducted for nine (09) residents. All medications quantities were maintained and documented in the correct amounts. At 3:30 p.m. on 04/30/25, LPA conducted a file review for resident and personnel records. All files were complete and available for audit. LPA also reviewed the most recent fire safety inspection from 11/26/24 in which all systems passed. The most recent fire safety drill was conducted on 04/26/25. Liability insurance and surety bond were both current.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Nicholas Reed
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2025
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: 05/01/2025
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
At the main entrance, LPA observed a designated smoking area. A doorbell was posted at the front for after-hours entry along with a sign with two (02) phone numbers listed. The designated smoking area at the front contained artificial shrubs and an umbrella for shade. Postings were observed inside for COVID precautions, emergency contacts, Ombudsman contacts, confidential complaint contacts, facility license, facility sketch, emergency disaster plan, administrator certificate, personal rights, rights of resident and family councils, theft and loss policy, nondiscrimination notice, normal and alternate menus, and activity calendars and reminders. Walls, floors, windows, screens, and blinds were clean, free from stains, and in good repair.

An activity room near the reception desk had a television, exercise equipment, a piano, a sound system, and sufficient activity space. Activities were observed and conducted at 10:00 a.m. today and yesterday, and a live musical performance occurred around 10:30 a.m. today. The reception area including seating, board games, an administrator office, a business office, and mailboxes. Personnel files were stored and locked in the business office.

At approximately 11:00 a.m. on 04/30/25, a fully-charged fire extinguisher was observed near the main entrance. It was last inspected on 06/12/24 and inspected by facility staff every month thereafter. At 11:10 a.m on 04/30/25 the room temperature was measured to be 71 degrees Fahrenheit.

Rooms 101, 110, 219, and 209 were inspected. All four (04) rooms contained functional smoke alarms, appropriately furnished bedding, chairs, nightstands, storage, lighting, and bathrooms with paper towels, liquid soap, grab bars near the toilets and showers, and non-skid mats or strips in the shower. All rooms were clean and in good repair. Call systems in the rooms were tested and deemed operational. Staff attended to the calls within one (01) to ten (10) minutes. Water temperatures in bathrooms were measured to be between 105.4 and 109.8 degrees Fahrenheit.

The second floor contained a medication room, activity room, and more resident rooms. The medication room contained a fully-stocked first aid kit, inaccessible medications, and locked medication carts with secondary locks for controlled substances. The activity room contained reading material, games, puzzles, and exercise equipment. Fire doors were observed in hallways. Fire sprinklers were observed throughout the building. Water and coffee was available on the first and second floors.

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

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC809 (FAS) - (06/04)
Page: 3 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: 05/01/2025
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
The third floor was unoccupied. The rear elevator accessed the third floor but was inoperable. The facility has scheduled maintenance and informed The Department of all updates. A final inspection is set for 05/02/25. Two (02) out of two (02) stairwells had emergency evacuation chairs at the tops of the stairwells. No hazards were observed in stairwells or emergency exit paths. All emergency exits were unlocked. All electrical rooms, maintenance rooms, and roof access doors were locked. The garage was free of hazards. The courtyard contained plants and trees and two (02) shaded seating areas.

LPA observed three (03) dining areas near the kitchen. The kitchen contained an adequate supply of perishable, non-perishable, and emergency foods. The dishwashing area was free of debris and vermin. Appliances were in good condition. Cleaning solutions and sharps were inaccessible. At approximately 10:10 a.m. today, the walk-in freezer and refrigerator temperatures were measured to be -8 and 32 degrees Fahrenheit. Temperature and maintenance logs were observed near appliances. Two (02) washing machines and two (02) dryers were located in the laundry room. Both were in working order. Detergents were stored and locked.

During yesterday’s and today's inspection, the facility was in compliance with Title 22 regulations. No immediate health or safety hazards were observed.

Exit interview conducted. Copy of report provided.

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

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4