198603136-9-12-2024-31-AS-EMIR-DCJV4T-20250102150650

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603136
Report Date: 09/12/2024
Date Signed: 09/12/2024 02:18:59 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
09/05/2024 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20240905114457

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: 96	DATE:	09/12/2024
		UNANNOUNCED	TIME BEGAN:	09:34 AM
MET WITH:	Imelda Villanueva		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal belongings
Staff did not consult with resident's authorized representative regarding the sigining of documents
Staff did not provide resident's authorized representative with records
Staff are not meeting resident's hygiene needs
Staff are not meeting resident's diapering needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPA met with the Executive Director (ED), Imelda Villanueva, and advised her of the complaint. Today's investigation consisted of interviews with staff and residents. LPA also conducted a record review and a physical plant inspection.

Staff did not safeguard resident's personal belongings:
In regards to the allegation, it was reported that licensee failed to safeguard Resident 1's (R1) money from their account. It was also reported that R1's clothing/undergarments have gone missing. Interviews with the office busines manager/Staff 1 (S1) reveal that all of R1's finances are accounted for. The facility does manage R1's money, and they do provide R1 with statements and ledgers for transactions that are credited and debited into R1's account. In regards to missing funds, or $3400 that is unaccounted for, S1 stated

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

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-20240905114457

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: SAVANT OF BURBANK EAST	FACILITY NUMBER: 198603136
	VISIT DATE: 09/12/2024

NARRATIVE

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that payment went towards R1's life insurance to pay for cremation. R1 signed the forms for this on 04/15/24. A copy of this was obtained for review. In regards to R1's clothing and undergarments, nothing was ever reported missing. Review of R1's Personal and Property Valuables (LIC 621) confirm no entry for clothing or undergarments. Based on the information obtained, there was insufficient evidence to prove that staff did not safeguard the resident's personal belongings. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff did not consult with resident's authorized representative regarding the signing of documents:
In regards to the allegation, it was reported that R1, and or their responsible person was not consulted in signing an advanced directive for cremation. According to both the ED and S1, R1 was responsible for themselves until receiving Power of Attorney (POA) on 08/28/24. Prior to that, R1 managed their own affairs. Interview with R1 could not corroborate with the allegation made. Review of R1's records confirm that they signed an application with their life insurance for their cremation service, on 04/15/24, which was prior to the POA taking over for R1's decisions regarding their health care and finances. Based on the information obtained, there was insufficient evidence to prove that R1 and/or their authorized representative were not consulted with signing of documents. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff did not provide resident's authorized representative with records:
In regards to the allegation, it was reported that R1's POA did not receive R1's records that were requested. These records include R1's bank statements or facility ledgers for R1's cash resources. Interview with S1 confirm that the facility handles cash for R1. S1 does deny the allegation of not providing R1's POA with these records. S1 stated there was a mis-communication with the POA because the facility had an incorrect email address for the POA on file, which the initial request for records were sent. The requested records for R1's statements has since been emailed to the POA's correct email address on 09/04/24. Copy of this email transaction was obtained to confirm it was sent and receipt. Based on the information obtained, the allegation of staff not providing R1's POA with records that were requested are deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240905114457

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: SAVANT OF BURBANK EAST	FACILITY NUMBER: 198603136
	VISIT DATE: 09/12/2024

NARRATIVE

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Staff are not meeting resident's hygiene needs/Staff are not meeting resident's diapering needs:
In regards to the allegation, it was reported that facility staff is not showering R1, or washing R1's hair. It was also reported that staff are not meeting R1's incontinent needs by changing her diapers regularly, or clipping R1's toenails. Interview with administrator and staff deny the allegation. There is always staff presence to assist R1 with their hygiene and incontinent needs. R1 gets checked on every two hours to make sure they didn't have any accidents due to their incontinence. In regards to R1's toenails, the ED stated there is a podiatrist that comes once a month to manicure R1's nails, but in addition, staff also clips R1's nails at least once a week. Interview with S2 confirms that R1's nails are cut, or at least checked every week to insure it hasn't outgrown. Interviews made with ten (10) of ten residents do not corroborate with the allegations. Residents deny the allegation, and are satisfied that their needs are being met. Based on the information obtained, there was insufficient evidence to prove that staff are not meeting resident hygiene or incontinent needs. Therefore, the allegations are deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC9099 (FAS) - (06/04)

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