198603136-11-20-2023-31-AS-NMAN-D2TSGQ-20240226125219

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603136
Report Date: 11/20/2023
Date Signed: 11/20/2023 06:12:20 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
11/17/2023 and conducted by Evaluator Antonia Alvizar

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20231117092248

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:	11/20/2023
		UNANNOUNCED	TIME BEGAN:	05:29 PM
MET WITH:	Executive Director, Imelda Villanueva		TIME COMPLETED:	06:15 PM

ALLEGATION(S):

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Staff do not respond to resident's call button in a timely manner

INVESTIGATION FINDINGS:

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

Staff do not respond to resident's call button in a timely manner.
It is alleged that no one answers call light, the staff come two (2) hours later and sometimes staff never answer it at all.

To investigate this allegation, At 10:15AM LPA requested resident and staff roster. LPA and ED conducted physical plant tour at 10:30AM. During physical plant tour LPA turned on the call button on room #218 and other randomly selected resident rooms. LPA requested copies of R1’s file which include the following documents: Emergency Information, Physician Rport, Individual Service Plan, and other relevant documents

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: 11/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023

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 31-AS-20231117092248

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: 11/20/2023

NARRATIVE

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to the investigations at 11:00AM and interviewed ED and three (03) staff and ten (10) residents randomly selected between 10:45:00AM to 3:30PM.

During physical plant tour LPA Alvizar tested call button for room #218 and observed staff answering to call button within eight minutes. In addition, LPA tested other randomly selected resident's call button and staff answered the call between three (3) to eight (8) minutes. R1 indicated that staff do answer to call button but it takes longer then expected. R2 indicated that when press the call button staff respond fast. Staff interviews revealed that they respond to all button calls from residents in a timely manner. Six (06) out of ten (10) residents stated that staff do respond to call button but sometimes they takes them a while to answer. Three (03) out of ten (10) residents indicated that they do not used the call button. One (01) out of ten (10) residents indicated that they use their phone to call staff for assistance.

Based on inspection, observation and interviews, there is no sufficient information to support the allegation. Therefore, the allegation is 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 provided to Villanueva.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023

LIC9099 (FAS) - (06/04)

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