198603136-2-14-2024-31-AS-NMAN-D2TT2M-20240226132059

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603136
Report Date: 02/14/2024
Date Signed: 02/14/2024 04:20:35 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, 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
02/06/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20240206085857

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: 97	DATE:	02/14/2024
		UNANNOUNCED	TIME BEGAN:	09:31 AM
MET WITH:	Imelda Villanueva		TIME COMPLETED:	04:32 PM

ALLEGATION(S):

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Staff do not provide adequate hygiene care to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to this facility to investigate the above allegations. LPA met with the Executive Director, Imelda Villanueva, and explained the reason for the visit.

--- Staff do not provide adequate hygiene care to resident.

It was alleged that Resident #1 (R1) smelled awful and looked like R1 had not bathed in a long time. To investigate the allegation, on 02/14/2024 LPA conducted a physical plant tour at around 10:00 AM, interviewed four (04) staff between 11:00 AM – 12:30 PM and interviewed ten (10) residents from 1:00 PM to 2:30 PM. During physical plant tour and interviews, LPA did not experience any malodor and all interviewed residents were clean and well-groomed including R1.
(CONT on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

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 31-AS-20240206085857

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BURBANK SENIOR VILLA EAST	FACILITY NUMBER: 198603136
	VISIT DATE: 02/14/2024

NARRATIVE

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During interviews with staff, all staff stated that residents who require shower assistance have a schedule and are showered two (02) to three (03) times a week or more if needed. During interviews with residents, six (06) out of ten (10) residents stated that they have a shower schedule and staff adhere to it. Three (03) out of (10) residents stated they are independent and do not require shower assistance. LPA was unable to complete interview with R1 as they repeatedly changed their response to the same interview question.

Based on observations and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted during the visit.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

LIC9099 (FAS) - (06/04)

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