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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603137
Report Date: 12/18/2024
Date Signed: 12/18/2024 11:09:11 AM

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
12/11/2024 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20241211152351
FACILITY NAME:SAVANT OF BURBANK WESTFACILITY NUMBER:
198603137
ADMINISTRATOR:VALDEZ, SILVIAFACILITY TYPE:
740
ADDRESS:1911 GRISMER AVETELEPHONE:
(818) 295-2727
CITY:BURBANKSTATE: CAZIP CODE:
91504
CAPACITY:100CENSUS: 96DATE:
12/18/2024
UNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Emily CaluagTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Illegal Eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegation. LPA met with the Wellness Coordinator, Emily Caluag, and advised her of the complaint. Today's investigation consisted of interviews with the wellness coordinator, Staff 1 (S1), Resident 1 (R1), record review and a physical plant inspection. Regional Director, Nirjara Acharya was advised over the telphone as she was unavailable in person.

In regards to the allegation, it was reported that R1 was sent to the hospital under 5150 hold on or around 12/02/24 and refused back to the facility at discharge. There was no anticipated discharge date given.

Interview with the wellness coordinator deny the allegation. R1 was sent to the hospital for an aggressive behavior towards another resident on 12/02/24. Resident families, law enforcement and the ombudsman were all notified. R1 was assessed and according to the telehealth evaluation, a 5150 hold was ordered.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
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 2
Control Number 31-AS-20241211152351
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 WEST
FACILITY NUMBER: 198603137
VISIT DATE: 12/18/2024
NARRATIVE
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R1 remained at the hospital until officially discharged by the physician at the hospital on 12/11/24. At discharge, facility staff conducted their assessment and re-appraisal of R1, to check for any changes, and to insure the facility can continue to meet R1's needs. R1 was admitted back to the facility 12/11/24.

Attempts was made to interview R1, but due to R1's diagnosis, R1 was not cooperative with the interview.

Review of R1's records, which include the Incident Report (IR) and discharge papers confirm R1's hospitalization under 5150 for aggressive behavior from 12/03/24 to 12/11/24.

Based on the information obtained, there was insufficient evidence to prove that R1 was evicted illegally. Therefore, the allegation is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2