198603136-3-21-2025-31-AS-NMAN-DFENGE-20250404102700

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603136
Report Date: 03/21/2025
Date Signed: 03/21/2025 03:31:14 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
07/19/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20240719155324

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:	12:15 PM
MET WITH:	Imelda Villanueva		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Staff are not properly addressing issue with bedbugs

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.

---Staff are not properly addressing issue with bedbugs.

It was alleged that facility has bedbugs and do not have the correct treatment plan set up to get rid of the problem. To investigate the allegation, on 07/24/24 LPA Antonia Alvizar-Ettima conducted a physical plant tour, interviewed nine (09) residents and five (05) staff at around 1:50p.m. and requested documents at 2:40p.m.
At the time of inspection, LPA Alvizar-Ettima did not observe bed bugs in R1’s room. Document reviewed from ORKIN Pest Control revealed that R1’s room #228 was inspected and treated for bed bugs.
(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)

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Control Number 31-AS-20240719155324

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 interviews with staff, maintenance staff revealed that resident #1 (R1) room #228 did have bed bugs. However, staff followed bed bug procedures to address the bed bugs in R1’s room as soon as R1 reported to staff. On 06/26/24 R1’s room was treated by ORKIN Pest. Five (05) days later ORKIN Inspector returned to conduct a follow up on bed bugs and R1 refused entrance of ORKIN Inspector in their room. Fourteen (14) days later R1 agreed to have room treated for bed bugs and the next day ORKIN Inspector treated R1’s room again.

During interviews with residents, R1 revealed that they have not seen any bed bugs in their room recently. All other residents stated they have not seen bedbugs.

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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