198603136-2-14-2024-31-AS-NMAN-D33PVM-20240305103922

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603136
Report Date: 02/14/2024
Date Signed: 02/14/2024 04:21:14 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
02/13/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20240213123732

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:	11:59 AM
MET WITH:	Imelda Villanueva		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff do not treat resident with respect.

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 treat resident with respect.

It was alleged that staff dismisses Resident #1 (R1) and won't have the electrical issue checked out. 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 nine (09) residents from 1:00 PM to 2:30 PM. During physical plant tour LPA did not witness or feel any electrical issues. During interviews with staff, all staff stated that they do not see any electrical issues that would cause R1 pain and offered to have resident moved to another room.
(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-20240213123732

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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All staff added that they volunteered to help R1 find a more suitable place that would give them comfort but R1 refused. During interviews with residents, R1 stated that staff are dismissive about the pain caused by the electricity in the walls and are not respectful as they are trying to get rid of them. R1 added that staff gives unreasonable orders to rearrange their room. The remaining eight (08) out of nine (09) residents stated that they are treated with respect and feel that staff are not dismissive.

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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