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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603136
Report Date: 07/28/2023
Date Signed: 07/28/2023 02:44:45 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
04/16/2021 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20210416101629
FACILITY NAME:LE BLEU CHATEAUFACILITY NUMBER:
198603136
ADMINISTRATOR:SOKOLOWSKI, MICHAELFACILITY TYPE:
740
ADDRESS:1900 GRISMER AVETELEPHONE:
(818) 843-3141
CITY:BURBANKSTATE: CAZIP CODE:
91504
CAPACITY:100CENSUS: 96DATE:
07/28/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Imelda Villanueva, administratorTIME COMPLETED:
11:30 PM
ALLEGATION(S):
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Staff unlawfully evicted a resident.
INVESTIGATION FINDINGS:
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***This licensing report issued on today visit, 07/28/23 will supersede licensing report dated 04/29/23. The finding will remain the same. ***

On 07/28/23, Licensing Program Analyst (LPA) Tao conducted a follow compliant investigation visit in order to redeliver the compliant investigation licensing report LIC 9099. LPA met with Imelda Villanueva, administrator and discussed the purpose of the visit.

On 04/20/21, LPA Tao conducted telephone interviews with Licensee. LPA obtained Resident roster and Staff roster. LPA requested the following records: Resident #1’s admission agreement (eviction related section and Resident’s right), 30-day Eviction notice, House rules of eviction policy, and notice that sent to ombudsmen related to eviction. The due date of providing documents is 4/21/21. Licensee said that Resident #1 (R1) was still residing at the facility.
(-continued in LIC 9099 C-)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 28-AS-20210416101629
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: LE BLEU CHATEAU
FACILITY NUMBER: 198603136
VISIT DATE: 07/28/2023
NARRATIVE
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***This licensing report issued on today visit, 07/28/23 will supersede licensing report dated 04/29/23. The finding will remain the same. ***

LPA attempted to interview R1 but R1 went out. Staff #3 assisted with virtual facility tour for a Health and Safety check. Due to insufficient information available at this time, a further investigation is required.

On 04/29/22, at 11:00 AM, Licensing Program Analyst (LPA) Gail Johnson arrived at Burbank Senior Villa East, formerly named Le Bleu Chateau and conducted an unannounced subsequent complaint visit. LPA met with Manager Marili Barajas. LPA Johnson explained the purpose of the visit. During the visit, LPA reviewed and obtained the following documents: 30-day notice and fax receipt to CCL, rent payment invoices, R1 Resident Departure Form, Admission Agreement, County of Los Angeles Sheriff’s Department Receipt for Possession of Real Property (May 3, 2021), R1 Face Sheet, and R1 Physician’s report. LPA conducted interviews with House Manager Marili Barajas and R1.

Regarding allegation: Staff unlawfully evicted resident. It was alleged that resident #1 (R1) was being evicted by the facility due to nonpayment of monthly rent. R1 has numerous medical conditions that would make it unsafe for R1 to be homeless and residing on the street. The investigation revealed the following: based on LPA Johnson’ and LPA Tao’s interviews conducted with Resident #1 (R1) and facility staff, review of records R1 facility records; 30-day notice dated 10/20/2020. Fax cover sheet sent to CCLD, R1’s rent payment invoices, R1 Resident Departure Form, R1’s Admission Agreement, R1’s Face Sheet, R1’s Physician’s report and Los Angeles County Sheriff’s Department Receipt for Possession of Real Property dated 11/23/20.

LPA Johnson interviewed with House Manager Barajas, who stated that the 30-Day Notice was issued to R1 on 10/20/21 for failure to pay monthly rent. R1 was admitted to the facility on 07/29/20 and stopped paying rent in October of 2020. House Manager Barajas stated the resident was not evicted and staff offered R1 with assistance to secure a placement at a new location and/or facility, however, R1 declined assistance from staff and remained residing at the facility until R1 independently decided to move out of the facility on April 19, 2021. LPA Johnson conducted an interview with R1, who stated that R1 understands the purpose for the eviction notice was issued to R1 for failure to pay monthly rent and R1 made the decision to move out of the facility and lives independently.
(-continued in LIC 9099 C-)
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20210416101629
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: LE BLEU CHATEAU
FACILITY NUMBER: 198603136
VISIT DATE: 07/28/2023
NARRATIVE
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***This licensing report issued on today visit, 07/28/23 will supersede licensing report dated 04/29/23. The finding will remain the same. ***

Upon R1’s departure from the facility in April 2021, the Los Angeles Sherriff’s Department posted an order of Receipt of Real Property on R1’s resident room door. Based on evidence gathered, LPA did not find sufficient evidence to support the above-mentioned allegation. The 30-Day eviction issued to R1 on 10/20/21 was lawful, the facility did not evict R1 from the facility unlawfully and pursued an unlawful detainer against R1.

Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

Exit interview conducted with Imelda Villanueva. and a copy of the Licensing Report was provided during visit.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3