Tarzana Manor

Type of visit: Required - 1 Year

At approximately 8:45 a.m. on 12/30/25, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later the licensee and disclosed the reason for the visit. A file review was conducted prior to today’s visit. The facility was last visited on 11/26/24 for a complaint visit. It is a single story building with five (05) bedrooms, three (03) bathrooms, kitchen, laundry room, common areas, and outdoor areas. It has an approved fire clearance for six (06) nonambulatory residents, of which five (05) may be bedridden. Approved hospice waivers for five (05). LPA observed a maintained front yard. Postings at the front and in the hallway included COVID precautions, facility license, confidential complaints contacts, ombudsman contacts, emergency disaster plan, rights of resident councils, personal rights, and the facility sketch. Walls, floors, windows, screens, and blinds were clean and in good repair. At 8:55 a.m. LPA measured the room temperature to be 76 degrees Fahrenheit. Two (02) residents were observed in the dining room watching television. Two (02) staff members were observed cleaning and preparing lunch. The living room contained a television, reading material, exercise equipment, and furniture in good repair. A fireplace was appropriately covered and turned off. Medications were locked near the main entrance and under the counter. The facility has five (05) bedrooms. One (01) bedroom is designated as a staff room. The staff room was unlocked and free of hazards. All bedrooms contained a chair, lamp, nightstand, storage, bell or call system, and a bed with adequate bedding. All furnishings were clean and in good condition. All rooms had hospital beds with wheels in the locked position. The facility has three (03) bathrooms. Two (02) bathrooms are private to Bedrooms #3 and #4, and one (01) is shared. All bathrooms contained liquid soap, paper towels, trash can with a tight fitting lid, grab bars near the toilet and shower, commodes, and a non-skid mat in the shower. At approximately 9:30 a.m. LPAs measured the water temperature in the shared bathroom to be 106.2 degrees Fahrenheit. Interview with Staff #1 (S1) at 9:35 a.m. today revealed chemicals were stored below the sink, but the lock recently broke, so all chemicals are stored near the laundry area. LPA heard the house telephone ring at 9:40 a.m. The phone was deemed operational. LPA observed an adequate supply of perishable and non-perishable foods in the kitchen. Appliances were in good condition. Sharps were locked under the counter. The stove surface and hood were clean. A washing machine and dryer were located in the laundry area. Both were in working order. Detergents and cleaning supplies were locked near the appliances. LPA observed a shaded patio area in the rear of the facility. The patio contained furniture in good condition. A fence on the southeast side of the facility was falling into the neighbor’s yard. Interview with the licensee at approximately 11:00 a.m. revealed the neighbor next door is new and is responsible for fixing the fence. The licensee has a plan to restore the fence properly. All emergency exit paths were free from obstructions. Two (02) out of two (02) exit gates were unlocked. Four (04) out of four (04) auditory alarms were turned on and functioning. Fire sprinklers were located throughout the facility. At 11:30 a.m., smoke and carbon monoxide detectors were tested and operational. At approximately 11:35 p.m. LPA observed a fully charged fire extinguisher in the kitchen. It was last tested on 05/16/2024 with a tag attached. At approximately 11:00 a.m. LPA reviewed staff and resident files. All files were complete and available for audit. During 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.the state’s words, verbatim · CDSS document, Dec 30, 2025

Type of visit: Required - 1 Year

At 10:00 a.m. on 11/26/2024, Licensing Program Analysts (LPAs) Nicholas Reed and Angelica Segovia conducted an unannounced annual inspection. LPAs met with staff and disclosed the reason for the visit. LPAs contacted the licensee by telephone at approximately 10:30 a.m. and disclose the reason for the visit. A file review was conducted prior to today’s visit. The facility was last visited on 03/15/2024 for a complaint visit. It is a single story building with five (05) bedrooms, three (03) bathrooms, kitchen, laundry room, common areas, and outdoor areas. It has an approved fire clearance for six (06) nonambulatory residents, of which five (05) may be bedridden. Approved hospice waivers for five (05). LPA observed a maintained front yard. A screening station at the front contained surgical masks, N95 masks, sanitizer, a digital thermometer, and a visitor log. Postings at the front included COVID precautions, facility license, confidential complaints contacts, ombudsman contacts. Additional postings near the kitchen included the emergency disaster plan, rights of resident councils, personal rights, and the facility sketch. Walls, floors, windows, screens, and blinds were clean and in good repair. At 10:20 a.m. LPAs measured the room temperature to be 76 degrees Fahrenheit. Three (03) residents were observed in the dining room drinking tea. Two (02) staff members were observed cleaning and preparing lunch. The living room contained a television, reading material, exercise equipment, and furniture in good repair. A fireplace was appropriately covered and turned off. Medications were locked near the main entrance. The facility has five (05) bedrooms. One (01) bedroom is designated as a staff room. The staff room was unlocked and free of hazards. All bedrooms contained a chair, lamp, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. All rooms had hospital beds with wheels in the locked position. The facility has three (03) bathrooms. Two (02) bathrooms are private to Bedrooms #3 and #4, and one (01) is shared. All bathrooms contained liquid soap, paper towels, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At approximately 10:30 a.m. LPAs measured the water temperature in Bathroom #1 to be 112.5 degrees Fahrenheit. LPAs called the house telephone at 10:40 a.m. The phone was deemed operational. LPA observed an adequate supply of perishable and non-perishable foods in the kitchen. Appliances were in good condition. Sharps and cleaning solutions were locked under the sink. The stove surface and hood were clean. A washing machine and dryer were located in the laundry area. Both were in working order. Detergents and cleaning supplies were locked near the appliances. LPA observed a patio area in the rear of the facility. The patios contained furniture in good condition. All emergency exit paths were free from obstructions. Exit gates were unlocked. Four (04) out of four (04) auditory alarms were turned on and functioning. Fire sprinklers were located throughout the facility. At 12:25 p.m., smoke and carbon monoxide detectors were tested and operational. At approximately 12:35 p.m. LPA observed a fully charged fire extinguisher in the kitchen. It was last tested on 05/20/2024 with a tag attached. At 11:00 a.m. LPAs reviewed staff and resident files. All files were complete and available for audit. During 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.the state’s words, verbatim · CDSS document, Nov 26, 2024

Allegation investigated: Staff did not seek medical attention for resident in a timely manner

At 8:35 a.m. on 03/15/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced, subsequent complaint visit. LPA met with Staff #1 (S1) and disclosed the reason for the visit. The licensee called LPA at 10:00 a.m. to designate S1 to sing today's reports. Regarding the allegation “Staff did not seek medical attention for resident in a timely manner” it was alleged facility staff did not provide timely care when Resident #1 (R1) was “in respiratory distress and septic”. To investigate the allegation above, LPAs Reed and Comer interviewed the licensee and three (03) staff between 11:20 a.m. and 12:30 p.m. on 03/05/2024 and reviewed records pertinent to the investigation at 12:00 p.m. including but not limited to an admission agreement, medical assessment, identification form, and consent forms. Today, LPA reviewed hospital records of R1 at 8:45 a.m. and toured the facility at 9:50 a.m. Unsubstantiated Interviews with three (03) out of three (03) staff and the licensee confirmed that R1 had no signs of infection, sepsis, or any symptoms of illness, no diagnosis of sepsis, and no physician’s order or prescription for antibiotics to address an infection. Interview with S1 at 11:20 a.m. on 03/05/2024 revealed R1 was last hospitalized on 02/12/2024. Record review at 12:00 p.m. on 03/05/2024 revealed R1 was admitted on 02/12/2024 for syncope and returned to the facility on 02/15/2024. R1 returned with two new physician’s orders for eye drops and a medication for heart arrhythmia. S1 confirmed R1 was assisted with all current and new medications. Around 11:00 p.m. on 02/26/2024, S1 and two (02) other staff noticed R1 having difficulty breathing. S1 called 9-1-1 and performed CPR until paramedics arrived. Record review of hospital records revealed R1 was admitted to Kaiser Woodland Hills around 2:30 a.m. on 02/27/2024 with low blood pressure and low blood oxygen levels. R1 was diagnosed with septic shock with pneumonia suspected as the source of the infection. Based on interviews and record review, facility staff followed all physician’s orders and sought medical attention promptly when R1 exhibited distress. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. No immediate health and safety risks were observed during this visit. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Mar 15, 2024 · control 31-AS-20240229145911

Allegation investigated: Staff did not ensure that resident's records were maintained as necessary

At 11:20 a.m. on 03/05/2024, Licensing Program Analysts (LPAs) Nicholas Reed and Raymond Comer conducted an unannounced complaint visit. LPAs met with staff and later the administrator and disclosed the reason for the visit. To investigate the allegation above, LPAs interviewed the administrator and staff between 11:20 a.m. and 12:30 p.m. today and reviewed records pertinent to the investigation at 12:00 p.m. today including but not limited to an admission agreement, medical assessment, identification form, and consent forms. Regarding the allegation “Staff did not ensure that resident's records were maintained as necessary” it was alleged the records of Resident #1 (R1) were not provided to emergency responders when requested. Interview with Staff #1 (S1) at 11:45 a.m. today revealed that R1 was hospitalized on 02/14/2024. Substantiated Emergency responders took R1’s complete file with them and did not return the file to the facility. The facility attempted to obtain the files from the emergency responders and the hospital but was unsuccessful. Emergency responders came again for R1 on 02/26/2024 and were unable to obtain R1’s files. Record review today revealed R1 had an incomplete medical assessment which was needed by emergency responders. Based on interviews and record review, the facility did not ensure the R1’s records were maintained at the facility. Therefore, the allegation is deemed SUBSTANTIATED at this time. A deficiency is issued on the attached LIC 809-D page. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Mar 5, 2024 · control 31-AS-20240229145911

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(2) · Plan of correction due date: Mar 15, 2024

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (2) To have their records and personal information remain confidential and to approve their release, except as authorized by law. This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above in one (01) out of five (05) residents which poses a potential Health, Safety, or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 5, 2024

Plan of correction: Licensee has agreed to acquire a new copy machine to maintain and provide all resident records.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.