197607065-1-3-2024-28-AS-EMIR-D2VQUY-20240228112933

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607065
Report Date: 01/03/2024
Date Signed: 01/03/2024 12:58:21 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
12/30/2022 and conducted by Evaluator Evelin Rios

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221230151413

FACILITY NAME:	BURBANK HILLS RESIDENTIAL CARE FACILITY		FACILITY NUMBER:	197607065
ADMINISTRATOR:	DINA ALGER		FACILITY TYPE:	740
ADDRESS:	425 UNIVERSITY AVENUE		TELEPHONE:	(818) 588-3122
CITY:	BURBANK	STATE: CA	ZIP CODE:	91504
CAPACITY:	6	CENSUS: 5	DATE:	01/03/2024
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Janet Santiano		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff took resident belongings.
Facility has vermin.
Staff not providing adequate food service.
Licensee speak inappropriately to resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 01/03/24 at 11:30 a.m. Licensing Program Analyst (LPA) Evelin Rios conducted a subsequent complaint visit to this facility to conclude the investigation regarding the above allegations. LPA was greeted by staff Janet Santiano, who called the administrator Dina Alger to inform them LPA was at the facility. LPA informed the administrator the purpose of the visit. Administrator was unable to meet LPA at the facility and designated Janet to sign todays report. During the course of the investigation, on 01/09/22, from 10:15 a.m. to 11:43 a.m. LPA Rios conducted interviews of four (4) out four (4) residents and three (3) out three (3) staff including the Administrator. From 11:04 a.m. to 11:43 a.m. LPA reviewed resident files and obtained copies of pertinent information.

Allegation #1: Staff took resident belongings. In regards to the allegation is was reported, staff took several items from resident #1 (R1) had with them prior to moving into the facility. LPA's interview with staff and administrator on 01/09/22, denied the allegation.
(Cont. on LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 28-AS-20221230151413

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BURBANK HILLS RESIDENTIAL CARE FACILITY	FACILITY NUMBER: 197607065
	VISIT DATE: 01/03/2024

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

During physical plant tour LPA did not observe items mentioned in the complaint outside of other residents bedrooms. According to the administrator on 01/09/22. R1 denied to have their items inventoried. R1's admission agreement indicated they denied to have items inventoried. Based on the information obtained, 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 UNSUBSTANTIATED at this time.

Allegation #2: Facility has vermin. In regards to the allegation it was reported, there are roaches and spiders in the facility. LPA's interview with staff and administrator on 01/09/22, denied the allegation. During physical plant tour LPA did not observe roaches or spiders in the facility. Administrator informed LPA that at some point in the past prior to R1 moving in she had an exterminator work on the house but administrator could not provide a receipt or service performed by the exterminator. Based on the information obtained, 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 UNSUBSTANTIATED at this time.

Allegation #3: Staff not providing adequate food service. In regards to the allegation it was reported, there has been hair in R1's food several times while at the facility. LPA's interview with staff and administrator on 01/09/22, denied the allegation. During physical plant tour LPA observed staff prepare meals for residents for lunch and LPA observed staff wash their hands before handling food and the area where food was being prepared was clean and clear of clutter. LPA also observed residents eating their meals with no apprehension. Administrator informed LPA R1 mostly requested outside food and would refuse to eat meals prepared at the facility. According to the administrator they would comply and bring outside food for R1. Based on the information obtained, 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 UNSUBSTANTIATED at this time.

Allegation #4: Licensee speak inappropriately to resident. In regards to the allegation it was reported, licensee Dina, would raise her voice at R1 when they would complain about hair in their food. LPA's interview with staff and administrator on 01/09/22, denied the allegation and revealed R1 would yell at them. Based on the information obtained, 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 UNSUBSTANTIATED at this time.
Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2