198603136-12-9-2024-31-AS-NGID-DC3PUH-20241218103735

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603136
Report Date: 12/09/2024
Date Signed: 12/09/2024 12:20:26 PM

Substantiated

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
09/17/2024 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20240917153803

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: 93	DATE:	12/09/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Imelda Villanueva- executive director (ED)		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff forced resident to cut resident's hair.

INVESTIGATION FINDINGS:

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This is an amended to the original report issued 9.26.2024. Additional information was added to clarify the investigation. A subsequent visit is made today 12.9.2024 at the facility to close out the investigation regarding the above allegation.

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an initial complaint visit to address the allegation mentioned above. LPA was greeted by Megan Torres (S2) who is the wellness director of the facility. At 11 AM Imelda Villanueva (S1) who is the executive director (ED) arrived and LPA explained the reason for the visit.

Entrance interview conducted.

At 10 AM LPA conducted a physical plant tour to ensure the health and safety of the residents in care.
Continue to LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024

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-20240917153803

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: 12/09/2024

NARRATIVE

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Allegation: Staff forced resident to cut resident's hair.

Regarding the allegation above it is alleged that staff forced resident to cut resident's hair. Interviews with executive director (ED), six (6) staff, and nine (9) out of ten (10) residents, who were able to communicate, indicated that no resident gets a haircut against their will. In addition, LPA was provided with pictures of R1 from September 12, 2024 and LPA observed that shoulder length haircut was cut from waist length with R1 consent because their hair was very tangled. During initial visit on 9.26.2024 R1's hair was tidy with no tangles.

LPA interview R1 on 10.15.2024 at 11:14AM at the common area. Interview revealed that R1 does not want to get a hair cut. Interview with staff revealed that R1 needed a haircut because their hair was very tangled irregardless of R1 not agreeing to get a haircut at that time. Staff did not produced a new Appraisal Needs and Service Plan (LIC 625) to address R1 hair issue. Staff failed to call R1 Power of Attorney (POA) to ask permission to cut R1's hair. Deficiency will be cited on LIC 9099-D.

Based on information obtained through interviews and record reviews this allegation is deemed substantiated at this time.

Exit interview conducted. A copy of this report was given to Executive director.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240917153803

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/09/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/09/2024 Section Cited CCR 87468.1(a)(3)	1 2 3 4 5 6 7	(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating,	1 2 3 4 5 6 7	The Administrator will review regulation 87468.1(a)(3) and submit a written statement ensuring that they will adhere to them. POC: 12.9.2024
	8 9 10 11 12 13 14	sleeping, or elimination. This requirement is not met as evidenced by: Based on LPA interview and record review, staff violated R1 personal rights of cutting their hair w/o family permission, which poses an immediate health & safety and personal rights risk to the residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024

LIC9099 (FAS) - (06/04)

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