198603136-10-9-2024-31-AS-NMAN-DAH9RU-20241028233628

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603136
Report Date: 10/09/2024
Date Signed: 10/09/2024 03:35:46 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
07/02/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20240702155732

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: 94	DATE:	10/09/2024
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Executive Director, Imelda Villanueva		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff do not ensure care needs of residents are being met
Staff do not ensure a safe environment is provided for residents in care
Staff do not speak to residents in an appropriate manner
Licensee does not ensure staff are able to communicate with residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent visit for the above allegation. LPA met with Imelda Villanueva and explained the reason for the visit.

--- Staff do not ensure care needs of residents are being met

It was alleged that residents yell for help in the cafeteria, but staff just ignore residents. To investigate the allegation, on 10/09/2024 LPA conducted a physical plant tour at around 11:00am, interviewed four (04) staff from 12:00pm to 1:30pm and interviewed nine (09) residents from 1:30pm to 3:30pm. During the physical plant tour, LPA observed staff being attentive to residents’ needs during meal service. During interviews with staff, all staff stated they do not ignore residents when they call out for assistance. During interviews with resident, all residents stated they do not feel ignored by staff.

(CONT. on LIC 9099-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: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

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-20240702155732

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: 10/09/2024

NARRATIVE

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Based on observations and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Staff do not ensure a safe environment is provided for residents in care

It was alleged that there is a rug in front of the coffee station and a corner of the rug flips up and several residents have almost tripped on it. To investigate the allegation, on 10/09/2024 LPA conducted a physical plant tour at around 11:00am, interviewed four (04) staff from 12:00pm to 1:30pm and interviewed nine (09) residents from 1:30pm to 3:30pm. During the physical plant tour, LPA did not observe any flipped up rugs or other tripping hazards throughout the facility. During interviews with staff, all staff stated they are unaware of any flipped-up rugs in the facility that might be a tripping hazard. During interviews with resident, all residents stated they are unaware of any tripping hazards near the coffee station.

Based on observations and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Staff do not speak to residents in an appropriate manner

It was alleged that the staff are rude and dismissive to residents. To investigate the allegation, on 10/09/2024 LPA interviewed four (04) staff from 12:00pm to 1:30pm and interviewed nine (09) residents from 1:30pm to 3:30pm. During interviews with staff, all staff stated they are never rude or dismissive when speaking to residents. During interviews with resident, all residents stated they feel staff treat them with dignity and respect.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

(CONT. on LIC9099-C)

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240702155732

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: 10/09/2024

NARRATIVE

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--- Licensee does not ensure staff are able to communicate with residents

It was alleged that staff do not speak or understand English. To investigate the allegation, on 10/09/2024 LPA interviewed four (04) staff from 12:00pm to 1:30pm and interviewed nine (09) residents from 1:30pm to 3:30pm. During interviews with staff, all staff stated they are able to communicate with all residents effectively. During interviews with resident, all residents stated they are able to communicate with staff and that they are able to meet all of their needs.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards were noted during the visit.

Exit interview was conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

LIC9099 (FAS) - (06/04)

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