198603136-6-12-2023-28-AS-NMAN-CSTTP4-20230615145343

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603136
Report Date: 06/12/2023
Date Signed: 06/12/2023 03:33:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/15/2023 and conducted by Evaluator Antonia Alvizar

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230315122123

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: 96	DATE:	06/12/2023
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:			TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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People at faciity smoke marijuna
Facililty failed to provide a comfortable environment

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Antonia Alvizar made an unannounced subsequent complaint visit to complete investigation of the above stated allegations. LPA met the Executive Director, Imelda Villanueva and explained the reason for the visit.

1. Resident(s) at facility smoke marijuana.
2. Facility failed to provide a comfortable environment.

It was alleged that resident is smoking marijuana in the facility, which creates uncomfortable environment to the residents. Staff was informed and did nothing about it.
To investigate these allegations, during initial 10-day complaint visit conducted on 03/20/23. LPA conducted physical plant tour at 11:53 AM, requested copies of facility documents relevant to the investigations at 9:51AM and interviewed six (06) staff and nine (09) residents between 10:00AM to 3:19PM.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

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-20230315122123

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BURBANK SENIOR VILLA EAST	FACILITY NUMBER: 198603136
	VISIT DATE: 06/12/2023

NARRATIVE

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During physical plant tour LPA Alvizar inspected residents’ rooms and common areas and did not smell marijuana.
Staff revealed that they have not witnessed or heard of resident smoking marijuana, and they have not smelled the odor of marijuana in the facility. Five (05) out of nine (09) residents stated that they don’t smell marijuana and did not witness anyone smoking marijuana inside the facility. Four (04) residents verifies that they smell marijuana. However, they did not witness anyone smoking in the facility.
One of the residents admitted smoking marijuana. However, they smoke outside, away from the facility.

Based on inspection, observation and interviews, there is no sufficient information to support the allegations. Therefore, the allegations are UNSUBSTANTIATED at this time.

No immediate Health and Safety hazard is noted during this visit.

Exit interview conducted and a copy of the report was emailed.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

LIC9099 (FAS) - (06/04)

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