198603136-11-15-2024-31-AS-EMIR-DG6PXC-20250428114205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603136
Report Date: 11/15/2024
Date Signed: 11/15/2024 02:24:21 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.RO, 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
11/08/2024 and conducted by Evaluator Raymond Comer

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20241108153231

FACILITY NAME:	SAVANT OF BURBANK 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: 90	DATE:	11/15/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Imelda Villanueva		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff mishandled a resident's personal belongings-

Staff mishandled a resident's medications-

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On Friday, 11/15/24, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannounced initial 10-day complaint visit at the facility to investigate the above allegation(s). LPA met with the Administrator, Imelda Villanueva, and the reason for the visit was disclosed.

At 09:15 am, LPA conducted a physical plant tour; no health and safety issues were observed.

To investigate the allegation(s), LPA received facility resident roster, and staff roster. At 9:35 am, LPA conducted a review of Resident 1's (R1) file. Between 10:00 am and 11:30 am, LPA interviewed the Administrator, four (4) Staff, eight (8) Residents, and R1's Responsible Family Member (F1), via cellphone.

[LIC 9099C]- Continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024

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 3

Control Number 31-AS-20241108153231

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: SAVANT OF BURBANK EAST	FACILITY NUMBER: 198603136
	VISIT DATE: 11/15/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff mishandled a resident's personal belongings- It was reported that Staff did not provide assistance to Resident#1 (R1) upon moving out from the facility. The Reporting Party (RP) states R1 is concerned about the safekeeping of their personal items left at the facility.

LPA's review of R1's file, interviews with Staff, Residents, and Responsible Family Member, revealed the following: Staff state that R1 did not provide any verbal, nor documented, pre-notification prior to their final exiting of the facility. Per Staff, R1 did not like anyone touching their personal belongings and refused assistance from Staff when offered. Staff was told by R1 that "someone would come and pick my stuff later". Staff confirm that a friend of R1 did arrive later in the day to pick up a portion of R1's belongings; R1's remaining belongings are secured in the bedroom that R1 previously occupied, which is now locked and inaccessible to residents.
LPA interview with R1's responsible family member (F1) reveals they are aware that Staff have stored R1's remaining belonging for safekeeping. F1 confirms to LPA that they will be picking up R1's remaining belongings on November 16, 2024, and that R1 is in agreement with the scheduled pick up date. Seven (7) out of eight (8) residents interviewed by the LPA state that Staff provides them satisfactory service regarding the safekeeping of their personal belongings.

Based on the information obtained through LPA observation, records review, and interviews, it cannot be proven that staff is failing to provide safekeeping of residents personal belongings. Therefore, the allegation is deemed Unsubstantiated at this time.

Allegation: Staff mishandled a resident's medications- It was reported Staff did not allow R1 to take possession of their medications upon their final exit from the facility.

LPA observations, interviews with Staff, Residents, and Responsible Family Member (F1) revealed the following: Staff state that R1 refused to sign the medical release form allowing R1 to accept their medications. Per Staff, R1 said they "would come back later" to sign the release, and pick up their medications. LPA observation of medication room found all of R1's medications stored in safekeeping, to be given to R1 upon their return.

[LIC 9099C]- Continued

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20241108153231

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: SAVANT OF BURBANK EAST	FACILITY NUMBER: 198603136
	VISIT DATE: 11/15/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

F1 stated to LPA that, on November 16, 2024, they would be arriving with R1 to assist in the pick up of R1's belonging and medications. LPA review of R1's file reveals MAR records showing proper daily medications distribution to R1 by Staff from R1's date of admission, (DOA) until their final exit from the facility. Eight (8) out of eight (8) residents interviewed by LPA state that Staff provide required monitoring and distribution of resident medications.

Based on the information obtained through LPA observations, and interviews, it cannot be proven that staff is failing to safeguard residents' personal belongings. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3