<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603136
Report Date: 06/25/2024
Date Signed: 06/25/2024 02:14:13 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
06/17/2024 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20240617232750
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: 93DATE:
06/25/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Imelda VillanuevaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not prevent a resident from disturbing another resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Tuesday Cabiness met with Administrator Imelda Villanueva and informed her the reason of the visit. The following was determined:

It was alleged staff did not prevent a resident from disturbing another resident. During today’s visit, from 12pm to 230pm, LPA conducted a physical plant inspection, interviews, and reviewed resident and facility documents. Staff reported to LPA, that resident # 1 (R1) had issues with the roommate, resident # 2 (R2). LPA interviewed (R2), who confirmed the issues with (R1). To resolve the problem and the conflict, facility staff relocated (R1) to a different room with a new roommate. (R1) reported to LPA, the issues are resolved, and both residents are getting a long and mind their own business. LPA determined, that the facility can not always ensure that there will be no issues among residents who have roommates, but in an effort to resolve the conflict, the facility relocated (R1) and made the necessary changes. Therefore, based on interviews, the allegation is Unsubstantiated at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
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 1