198603136-3-21-2025-31-AS-NMAN-DFENR4-20250404104055

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603136
Report Date: 03/21/2025
Date Signed: 03/21/2025 12:13:40 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
05/24/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20240524142719

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: 92	DATE:	03/21/2025
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Imelda Villanueva		TIME COMPLETED:	12:25 PM

ALLEGATION(S):

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Licensee does not provide residents with sufficient living space.
Licensee does not provide residents with a safe living environment.
Licensee is not addressing mildew at facility.

INVESTIGATION FINDINGS:

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At around 9:30AM, Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to deliver the findings for the above stated allegations. LPA met with Executive Director (ED), Imelda Villanueva, and explained the reason for the visit.

---Licensee does not provide residents with sufficient living space.

It was alleged resident (R1)’s room is too small for two residents to move around. To investigate the allegation on 05/29/2024 at 3:20p.m., LPA Antonia Alvizar-Ettima conducted a physical plant tour, requested documents and interviewed one (01) staff and one (01) resident. On 01/22/2025 LPA Alvizar-Ettima conducted a physical plant tour at approximately 11:15a.m. and interviewed one (01) additional staff and nine (09) out of ninety-five (95) additional residents between 11:45am -1:05p.m.
(CONT. LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025

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-20240524142719

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: 03/21/2025

NARRATIVE

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During the physical plant tour, LPA Alvizar-Ettima observed that R1’s room is similar in size as the other rooms in the facility with enough space and clear paths to navigate the room safely. During interviews with staff, all staff stated all bedrooms have sufficient living space including R1’s bedroom. During interviews with residents, R1 stated room is too small for two residents to move around. All other residents stated the rooms have sufficient living space and had not concerns.

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

---Licensee does not provide residents with a safe living environment.

It was alleged that there is only one pull alarm signal in R1’s room that R1 and roommate has to share. To investigate the allegation on 05/29/2024 at 3:20p.m., LPA Antonia Alvizar-Ettima conducted a physical plant tour, requested documents and interviewed one (01) staff and one (01) resident. On 01/22/2025 LPA Alvizar-Ettima conducted a physical plant tour at approximately 11:15a.m. and interviewed one (01) additional staff and nine (09) out of ninety-five (95) additional residents between 11:45am -1:05p.m. During the physical plant tour, LPA Alvizar-Ettima observed all interviewed residents had a pull alarm string within their reach in room including R1. During interviews with staff, all staff stated pull alarms signal have a string for each resident to pull for assistance and this is a safe living environment. During interviews with residents, R1 stated there is only one pull alarm signal in R1’s room that R1 and roommate has to share. All other residents stated the do not have an issue sharing the pull alarm signal with their roommate.

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

---Licensee is not addressing mildew at facility.

It was alleged that rooms #228 and #214 have mold on the wall. To investigate the allegation on 05/29/2024 at 3:20p.m., LPA Antonia Alvizar-Ettima conducted a physical plant tour, requested documents and interviewed one (01) staff and one (01) resident.
(CONT. on LIC9099-C)

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240524142719

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: 03/21/2025

NARRATIVE

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On 01/22/2025 LPA Alvizar-Ettima conducted a physical plant tour at approximately 11:15a.m. and interviewed one (01) additional staff and nine (09) out of ninety-five (95) additional residents between 11:45am -1:05p.m. During the physical plant tour, LPA Alvizar-Ettima did not observe any mildew in rooms #228 and #214. During interviews with staff, all staff stated that mildew is always addressed in the facility. During interviews with residents, R1 stated rooms #228 and #214 have mold on the wall. All other residents stated there was no mildew in the facility and they had no concerns.

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 and a copy of the report was issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025

LIC9099 (FAS) - (06/04)

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