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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609362
Report Date: 10/25/2021
Date Signed: 10/26/2021 08:24:59 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:HEIGHTS AT BURBANK, THEFACILITY NUMBER:
197609362
ADMINISTRATOR:DAWN SMITHFACILITY TYPE:
740
ADDRESS:2721 WILLOW STREETTELEPHONE:
(818) 954-9500
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY:130CENSUS: 83DATE:
10/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Facility AdministratorTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced Required-1 year visit focusing on COVID-19 Infection Control Practices. LPA met with the Executive Director and explained the purpose of today's visit. LPA toured facility grounds. This is an 8 story facility. There are 106 apartments including the rooms at the Memory Care unit. There is a medication room, game room, activity room, movie theater, gym, beauty salon, computer room, library, bistro, dinning room, piano room, lobby and outside patios

The following were observed/inspected:
  • COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility, in all common rooms and hallways.
  • Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing.
  • All residents have their own private apartment.
  • Per Executive Director, "87% of residents are fully vaccinated" and "97% of staff are fully vaccinated"
  • Per Executive Director, the COVID booster vaccine is scheduled for 11/02/2021 for Residents and Staff that have been fully vaccinated and wish to receive it.
  • Medication reviewed for (6) residents (Resident #1 through Resident #6)
  • PPE supplies observed. PPE supplies for immediate use are stored inside the Executive Director's office. The bulk of PPE supplies are stored inside the storage room located on the 4th floor.
  • All common areas including entrances have a hand sanitizer dispenser. This applies to every floor and at every elevator entrance as well. All residents (except for memory care) have their own hand sanitizer and/or soap to use in their private apartment.
  • Staff responsible for direct care and supervision were observed wearing masks. Residents were socially distanced according to local public health guidelines.
  • Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed.
Exit interview conducted, a copy of this report and Appeal Rights were provided to Executive Director
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth IrraTELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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