198603136-1-18-2023-28-AS-MVAO-CPCSGM-20230224125209

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603136
Report Date: 01/18/2023
Date Signed: 01/18/2023 06:15:39 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/13/2023 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 28-AS-20230113122750

FACILITY NAME:	BURBANK SENIOR VILLA EAST		FACILITY NUMBER:	198603136
ADMINISTRATOR:	ACHARYA, NIRJARA		FACILITY TYPE:	740
ADDRESS:	1900 GRISMER AVE		TELEPHONE:	(818) 843-3141
CITY:	BURBANK	STATE: CA	ZIP CODE:	91504
CAPACITY:	100	CENSUS: 98	DATE:	01/18/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Marili Barajas, Office Manager.		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff yells at residents.

INVESTIGATION FINDINGS:

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At approximately, 10:00am Licensing Program Analyst (LPA), Angela Panushkina arrived to this facility in response to the above mentioned allegation. LPA met with the Office Manager and explained the reason for the visit.

LPA conducted a physical plant walk through, at approximately 10:30am, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. LPA did not observe any immediate health and safety issues during the visit.

LPA conducted interviews with the Office Manager, MedTech, two (2) staff members and ten (10) out of eleven (11) residents between 10:30am - 12:50pm. In addition, LPA reviewed facility records from 1:00pm to 2:00pm and obtained copies of pertinent documents relevant to the investigation.

Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

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

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230113122750

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: BURBANK SENIOR VILLA EAST	FACILITY NUMBER: 198603136
	VISIT DATE: 01/18/2023

NARRATIVE

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Allegation: Facility staff yells at residents.

To investigate this allegation LPA, Panushkina, interviewed the Office Manager and was informed that the facility staff members treat every resident with dignity and respect. The Office Manager denied ever hearing or seeing any of the staff members yelling at the residents. LPA was also informed that the facility has residents with hearing problems and due to their medical condition the staff members speak with them in a loud tone of voice. In addition, interview with the MedTech revealed that every time they administer medications to the resident they provide brief explanation of what is the medication for. The MedTech stated: "If anything changes, I always review in advance... In case they ask." Finally, interviews with nine (9) residents revealed that staff did not yell at any of them nor have they witnessed any staff yelling at other residents. Based on the information gathered during today's visit, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of this report issued.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC9099 (FAS) - (06/04)

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