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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609362
Report Date: 10/14/2022
Date Signed: 10/14/2022 02:55:53 PM


Document Has Been Signed on 10/14/2022 02:55 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
GREATER LA AC/SC, 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: 85DATE:
10/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:04 AM
MET WITH:Dawn Smith TIME COMPLETED:
03:09 PM
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Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced Required-1 year visit focusing on COVID-19 Infection Control Practices. LPA met with the Executive Director Dawn Smith 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 are 2 medication rooms, game room, activity room, movie theater, gym, beauty salon, computer room, library, bistro, dining 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.
· Water temperature measured between 115.9 degrees F and 119.7 degrees F which is within regulatory range.
· All residents have their own private apartment.
· Medication reviewed for (6) residents
· 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.

No deficiencies cited during today's visit.

Exit interview conducted, a copy of this report and Appeal Rights were provided to Executive Director Dawn Smith

SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto LopezTELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022
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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