198603136-3-30-2025-31-AS-NMAN-DFEPBV-20250404111059

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603136
Report Date: 03/30/2025
Date Signed: 03/30/2025 03:40:07 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
06/19/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20240619163442

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: 93	DATE:	03/30/2025
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Betty Jerez		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Licensee does not ensure the facility is in good repair.
Staff did not respond to resident's call button in a timely manner.
Staff did not assist resident with obtaining medical care.
Staff did not provide resident with personal care supplies.
Staff did not ensure resident rooms are cleaned adequately.
Staff denied resident food.
Staff spoke to resident in an inappropriate manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted a subsequent complaint visit to the facility to investigate the above allegations. LPA met with Betty Jerez and explained the reason for the visit.

---Licensee does not ensure the facility is in good repair

It was alleged that on 06/17/2024 facility had no hot water for two (02) days and the last three to four months, the air conditioner and thermostat do not work and it gets up to 89° Fahrenheit in their room. To investigate the allegation LPA conducted a physical plant tour and requested documents at around 10:30a.m., interviewed three (03) staff and nine (09) residents from around 12:00p.m.– 2:00p.m. During the physical plant tour, LPA observed that hot water was in working order and measured an average 112.6 degrees Fahrenheit. LPA also observed thermostats in working order including the room in question.

(CONT. on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2025

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-20240619163442

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: 03/30/2025

NARRATIVE

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A review of the maintenance notes revealed that the hot water problem was reported on 06/17/2024 and resolved 06/19/2024. During interviews with staff, all staff stated the issue was brought to their attention and it was resolved swiftly. Staff added they are not aware of any thermostat issues. During interviews with residents, all resident stated they do not recall the incidents of hot water and air conditioning issues and are not currently experiencing any.

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

---Staff did not respond to resident's call button in a timely manner.

It was alleged that when they use the call button staff never respond to assist. To investigate the allegation LPA conducted a physical plant tour at around 10:30a.m., interviewed three (03) staff and nine (09) residents from around 12:00p.m.– 2:00p.m. During the physical plant tour, LPA selected four (04) rooms at random and observed an average response time of six (06) minutes. During interviews with staff, all staff stated they respond to calls within five (05) minutes average and never ignore them. During interviews with residents, all resident stated staff respond to call buttons within five (05) to ten (10) minutes.

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

--- Staff did not assist resident with obtaining medical care.

It was alleged that staff say they are busy or do not have time when resident asked for help with scheduling a doctor's appointment. To investigate the allegation LPA interviewed three (03) staff and nine (09) residents from around 12:00p.m.– 2:00p.m. During interviews with staff, all staff they always assist residents with scheduling appointments and do not refuse assistance to anyone. Staff #1 (S1) added, if one (01) staff is busy, then they will ask someone else to assist that resident to schedule a doctor’s appointment.

(CONT on LIC 9099-C)

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 31-AS-20240619163442

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: 03/30/2025

NARRATIVE

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During interviews with residents, all resident stated staff are assisting with obtaining medical care.

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

---Staff did not provide resident with personal care supplies.

It was alleged that staff do not give enough towels because they run out of clean towels. To investigate the allegation LPA conducted a physical plant tour at around 10:30a.m., interviewed three (03) staff and nine (09) residents from around 12:00p.m.– 2:00p.m. During the physical plant tour, LPA observed clean towels available. During interviews with staff, all staff stated residents have plenty of clean towels available and they do not deny or hide clean towels from residents. During interviews with residents, all resident stated they have enough clean towels available.

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

--- Staff did not ensure resident rooms are cleaned adequately.

It was alleged that resident room gets too dirty with only once-a-week service. To investigate the allegation LPA conducted a physical plant tour at around 10:30a.m., interviewed three (03) staff and nine (09) residents from around 12:00p.m.– 2:00p.m. During the physical plant tour, LPA observed four (04) rooms at random and observed that all rooms were clean. During interviews with staff, all staff stated residents’ rooms are cleaned by housekeeping once a week and caregivers do light cleaning daily. During interviews with residents, all resident stated they feel the once a week housekeeping and caregivers doing light cleaning is sufficient.

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

(CONT. on LIC9099-C)

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2025

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240619163442

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: 03/30/2025

NARRATIVE

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---Staff denied resident food.

It was alleged that staff tells residents there is no more food even if there is some. To investigate the allegation LPA conducted a physical plant tour at around 10:30a.m., interviewed three (03) staff and nine (09) residents from around 12:00p.m.– 2:00p.m. During the physical plant tour, LPA observed a kitchen sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. During interviews with staff, all staff stated they do not lie about the availability of food or deny residents food. S1 added residents are offered breakfast, lunch, dinner and snacks. During interviews with residents, all resident stated staff does not lie about or deny them food.

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

---Staff spoke to resident in an inappropriate manner.

It was alleged that staff are mean and tell resident to “get out of my face” or “don’t talk to me.” To investigate the allegation LPA conducted a physical plant tour at around 10:30a.m., interviewed three (03) staff and nine (09) residents from around 12:00p.m.– 2:00p.m. During the physical plant tour, LPA observed staff being mean to residents. During interviews with staff, all staff stated they they are not mean and treat all resident with dignity and respect. During interviews with residents, all resident stated staff treat them with dignity and respect and don’t say things to them like, “get out of my face” or “don’t talk to me.”

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.

Interview conducted and a copy of the report issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2025

LIC9099 (FAS) - (06/04)

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