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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609362
Report Date: 01/19/2023
Date Signed: 01/19/2023 10:42:58 AM

Document Has Been Signed on 01/19/2023 10:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
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: 86DATE:
01/19/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:14 AM
MET WITH:Dawn Smith TIME COMPLETED:
10:45 AM
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
On 01/19/2023, Licensing Program Analyst (LPA) Troy Agard conducted an unannounced case management visit. Upon arrival at the facility, LPA was greeted by Dawn Smith, Administrator, and the purpose of the visit was explained. LPA conducted a Covid risk assessment. Based on the assessment, the facility is clear of Covid-19 infection.

The Woodland Hills South regional office received the following information: “The Heights at Burbank” (current management Oakmont Management Group LLC) is falsely advertising and confusing the public. They are advertising as, “Ivy Park at Burbank”, using the license number of, “The Heights at Burbank”, 197609362. Per the regional office, there has been no approval prior to the submission of a LIC 200 for a change of name request on 01/05/2023.

The facility currently has a census of 86 residents. Of which 1 resident is bedridden and 7 residents are on hospice. Facility is operating within capacity per a review of resident roster dated 01/19/2023. LPA reviewed the facility’s associations and found staff interviewed to be cleared and associated with the facility.

LPA toured the inside and outside grounds of the physical plant. LPA inspected the kitchen and observed a two-day perishable and a seven-day non-perishable food supplies. Knives and toxins were kept locked and inaccessible to residents. LPA inspected the dining room, resident bedrooms, bathrooms, and observed all rooms are well maintained. LPA observed all indoor and outdoor passageways are free from obstructions.

LPA requested the following documents, which some were received at the time of the visit:
1) Staff roster
2) Resident roster

Cont on 809C
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: HEIGHTS AT BURBANK, THE
FACILITY NUMBER: 197609362
VISIT DATE: 01/19/2023
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
3) An updated program plan (plan of operation)
4) An updated LIC 309

Items 3, and 4 are due to LPA by 01/30/2023

No immediate health and safety hazards were observed. The following deficiency was cited.

1) False Claims 87207 (see attached 809D)

An exit interview was conducted, and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/19/2023 10:42 AM - It Cannot Be Edited


Created By: Troy Agard On 01/19/2023 at 10:24 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
,
, CA

FACILITY NAME: HEIGHTS AT BURBANK, THE
FACILITY NUMBER: 197609362

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/30/2023
Section Cited
CCR
87207

1
2
3
4
5
6
7
 87207 False Claims
No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement was not met as evidence by:
1
2
3
4
5
6
7
Facility will submit documentation requested in the evaluation report by POC due date. The LIC 200 that was submitted on 01/05/2023 will be reviewed and subject to approval or denial. Documents must be sent on or before POC due date via fax or email.
8
9
10
11
12
13
14
Based on a record review and observation. The facility has changed the name on the building, website and is currently advertising under a different name other than what is licensed, prior to approval from licensing. This poses a potential health and safety risk to residents in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Angela J Kendrick
LICENSING EVALUATOR NAME:Troy Agard
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023


LIC809 (FAS) - (06/04)
Page: 3 of 3