198603136-3-3-2023-28-AS-MVAO-CQMUX6-20230406155749

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603136
Report Date: 03/03/2023
Date Signed: 03/03/2023 02:19:28 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/27/2023 and conducted by Evaluator Tuesday Cabiness

COMPLAINT CONTROL NUMBER: 28-AS-20230227090159

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: 92	DATE:	03/03/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Nirjara Acharya		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility does not have hot water.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness met with Executive Director (ED) Nirjara Acharya and informed her the reason of the visit.

From 1pm to 230pm LPA interviewed the ED and conducted a physical inspection of random resident's and employee bathrooms, on the first and second floor. Hot water ranged from temperatures of 105.8, 107.6, 110.6, and 111.2, which is in compliance with Licensing regulations. Although, the ED confirmed the hot water was out, a repair company, came the same day, and attempted to fix the boiler. The boiler needed a part, which was ordered and the boiler was fixed a day later. The ED, submitted an incident report, and all residents were notified that the hot water was not operable, but would be fixed. Therefore, based on physical plant inspection, and documentation received, the allegation is Unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

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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