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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603136
Report Date: 05/16/2024
Date Signed: 05/16/2024 11:36:36 AM

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
05/09/2023 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20230509163313
FACILITY NAME:BURBANK SENIOR VILLA EASTFACILITY NUMBER:
198603136
ADMINISTRATOR:ACHARYA, NIRJARAFACILITY TYPE:
740
ADDRESS:1900 GRISMER AVETELEPHONE:
(818) 843-3141
CITY:BURBANKSTATE: CAZIP CODE:
91504
CAPACITY:100CENSUS: 88DATE:
05/16/2024
UNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Imelda VillanuevaTIME COMPLETED:
11:35 AM
ALLEGATION(S):
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Unlawful eviction.
Staff speak inappropriately to resident in care.
Facility is in disrepair.
Staff withheld resident's mail.
Staff do not safeguard resident's belongings.
Residents smoke inside the facility.
INVESTIGATION FINDINGS:
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On 05/15/24, at 9:30am, Licensing Program Analyst (LPA) Perry Scott conducted a subsequent unannounced visit to the facility and was greeted by Imelda Villanueva, Administrator. LPA explained the purpose of this visit is to gather additional information and deliver findings for the allegations mentioned above.

The investigation consisted of the following: An initial complaint visit was completed by LPA Antonia Alvizar on 05/16/2023. A subsequent visit was completed by LPA Perry Scott on 05/15/2024. LPA investigated the allegations mentioned in this complaint; and conducted interviews with staff (S1-S5) and residents (R1-R10). Resident/Staff Roster, Pre-Placement Appraisal, ID/Emergency Info, Client Personal property, Admission Agreement, Warning Letter, House Rules, ISP, & Physicians Report for R1 were obtained from the facility.

Report continued on LIC9099-C

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1075
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: 424-544-1075
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
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 4
Control Number 31-AS-20230509163313
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: BURBANK SENIOR VILLA EAST
FACILITY NUMBER: 198603136
VISIT DATE: 05/16/2024
NARRATIVE
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The investigation revealed the following: Allegation #1- Unlawful eviction.

The details of the complaint alleged that the facility is evicting the resident on 05/10/2023 and the resident has not been issued an eviction notice. On 05/15/24, from 09:30am-02:00pm, LPA interviewed staff (S1-S5) and residents (R1-R10) regarding the allegation. 5 of 5 staff denied the allegation that the resident was given an Unlawful eviction. All staff (S1-S5) stated that the resident was never under the threat of eviction. Staff stated that the resident has a hoarding problem and was given a warning letter to address this problem. S1 stated that R1 has been doing better with this issue and seems to have it under control and no eviction is forthcoming. LPA interviewed R1-R10 about the allegation and 10 of 10 residents that were interviewed denied the allegation that the facility issued them an Unlawful eviction. Residents stated that they have never been issued an eviction notice by the facility and are all in good standing.

Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the facility issued an Unlawful eviction. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation # 2- Staff speak inappropriately to resident in care.

The details of the complaint alleged that the facility staff yells at the resident and calls the resident names. On 05/15/24, from 09:30am-02:00pm, LPA interviewed staff (S1-S5) and residents (R1-R10) regarding the allegation. 5 of 5 staff denied the allegation that Staff speak inappropriately to resident in care. All staff (S1-S5) stated that they have no knowledge of R1 being spoken to disrespectfully or in an inappropriate manner and deny that the resident has ever been called names by the staff. They state that they treat all the residents with dignity and respect. LPA interviewed R1-R10 about the allegation and 9 of 10 residents that were interviewed denied the allegation that Staff speak inappropriately to resident in care. Residents stated that they have never been spoken to in an inappropriate way nor have they witnessed any other resident being yelled at or intimidated by another staff or resident.

Based on interviews, there is insufficient evidence to support the allegation that Staff speak inappropriately to resident in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Report continued on LIC9099-C

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1075
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: 424-544-1075
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20230509163313
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: BURBANK SENIOR VILLA EAST
FACILITY NUMBER: 198603136
VISIT DATE: 05/16/2024
NARRATIVE
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Allegation # 3- Facility is in disrepair.

The details of the complaint alleged that the facility does not have any air conditioning or heating. On 05/15/24, from 09:30am-02:00pm, LPA interviewed staff (S1-S5) and residents (R1-R10) regarding the allegation. 5 of 5 staff denied the allegation that the Facility is in disrepair. All staff (S1-S5) stated that the facility does have air conditioning and heating in all rooms of the facility. LPA toured the facility and bedrooms and observed that the rooms are equipped with a working air conditioner and heating unit; and that the facility is not in disrepair. LPA interviewed R1-R10 about the allegation and 10 of 10 residents that were interviewed denied the allegation that the Facility is in disrepair. Residents stated that the facility and their rooms are equipped with an air conditioner and a heating unit; and that the facility is not in disrepair.

Based on interviews and observations, there is insufficient evidence to support the allegation that the Facility is in disrepair. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation # 4- Staff withheld resident's mail.

The details of the complaint alleged that the facility staff withholds the residents mail and sometimes it is lost by staff. On 05/15/24, from 09:30am-02:00pm, LPA interviewed staff (S1-S5) and residents (R1-R10) regarding the allegation. 5 of 5 staff denied the allegation that the Staff withheld resident's mail. All staff (S1-S5) stated that they have never withheld R1s mail and that once the mail is received it must be sorted and organized for each resident. Once that happens the residents can come to the front desk and pick up their mail. S1 further stated that if residents don’t come and pick up the mail for a couple of days, the staff takes it to their room. LPA interviewed R1-R10 about the allegation and 9 of 10 residents that were interviewed denied the allegation that Staff withheld resident's mail. Residents stated that they have never had their mail withheld from them and are satisfied with the facility and the way they process and distribute the mail.

Based on interviews, there is insufficient evidence to support the allegation that the Staff withheld resident's mail. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1075
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: 424-544-1075
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20230509163313
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: BURBANK SENIOR VILLA EAST
FACILITY NUMBER: 198603136
VISIT DATE: 05/16/2024
NARRATIVE
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Allegation # 5- Staff do not safeguard resident's belongings.

The details of the complaint alleged that the facility staff steals and/or loses the residents clothing. On 05/15/24, from 09:30am-02:00pm, LPA interviewed staff (S1-S5) and residents (R1-R10) regarding the allegation. 5 of 5 staff denied the allegation that Staff do not safeguard resident's belongings. All staff (S1-S5) stated that they have not had any complaints of theft in the facility and no knowledge of anyone complaining about theft. S1 stated the facility gives lock boxes to residents that have cash or valuables that they want to keep safe in their rooms. LPA interviewed R1-R10 about the allegation and 9 of 10 residents that were interviewed denied the allegation that Staff do not safeguard resident's belongings. Residents stated that they have not had any of their personal items stolen while living at the facility; and the staff does safeguard their belongings.

Based on interviews, there is insufficient evidence to support the allegation that Staff do not safeguard resident's belongings. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation # 6- Residents smoke inside the facility.

The details of the complaint alleged that the residents smoke in the facility. On 05/15/24, from 09:30am-02:00pm, LPA interviewed staff (S1-S5) and residents (R1-R10) regarding the allegation. 5 of 5 staff denied the allegation that Residents smoke inside the facility. All staff (S1-S5) stated that residents are not allowed to smoke in the facility and if it is found that they are they are given a verbal and written warning to stop this behavior. If it persists, they may be evicted for not following the house rules. LPA interviewed R1-R10 about the allegation and 9 of 10 residents that were interviewed denied the allegation that Residents smoke inside the facility. Residents stated that they have no knowledge of anyone smoking in the facility. They stated that it is not allowed and those who choose to smoke must go outside to the patio area.

Based on interviews, there is insufficient evidence to support the allegation that Residents smoke inside the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

No deficiencies were cited.

An exit interview was conducted with Imelda Villanueva, Administrator, and a hard copy of this report was provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1075
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: 424-544-1075
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4