198603137-10-15-2025-31-AS-NGID-DQPW49-20260126155711

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603137
Report Date: 10/15/2025
Date Signed: 10/15/2025 11:11:37 AM

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
01/03/2025 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20250103082700

FACILITY NAME:	SAVANT OF BURBANK WEST		FACILITY NUMBER:	198603137
ADMINISTRATOR:	VALDEZ, SILVIA		FACILITY TYPE:	740
ADDRESS:	1911 GRISMER AVE		TELEPHONE:	(818) 295-2727
CITY:	BURBANK	STATE: CA	ZIP CODE:	91504
CAPACITY:	100	CENSUS: 98	DATE:	10/15/2025
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Nancy Ruiz, Wellness Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff did not prevent residents from engaging in inappropriate interactions.

INVESTIGATION FINDINGS:

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At 10:15 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced subsequent complaint visit. LPA met with the Wellness Director Nancy Ruiz, and explained the reason for the visit.

An initial visit was conducted on 01/10/2025 and a subsequent visit was conducted on 09/30/2025. During course of the investigation, interviews and record review were made. At 10:10 AM, LPA requested resident and staff roster. At 10:20 AM, LPA requested copies of pertinent information which include, but not limited to Physician’s Report, Admission Agreement, Appraisal Needs and Services Plan, etc., relevant to the investigation. At approximately 10:30 AM, LPA conducted a physical plant tour. Between 11:00 AM – 12:45 PM, LPA conducted an interview with the Wellness Director, and nine (9) out of nine (9) residents During the subsequent visit, between 10:20 AM to 12:00 PM, LPA conducted additional interviews with the Executive Director (ED), two (2) MedTechs, and Maintenance Director (MD). LPA also gathered additional documents relevant to the investigation.
Continue on LIC 9099C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

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-20250103082700

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 WEST	FACILITY NUMBER: 198603137
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/15/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 10/22/2025 Section Cited CCR 87468.2(a)(4)	1 2 3 4 5 6 7	87468.2 Additional Personal Rights... (a) ...residents... shall have... (4) ... care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Staff will receive retraining on supervision and intervention procedures. The facility will ensure staff are assigned to monitor all common areas during resident use.
	8 9 10 11 12 13 14	Based on interviews, the facility failed to ensure adequate supervision when two residents engaged in inappropriate interactions in front of other residents and visitors in the lunch area on 01/01/25. This posed a potential health and safety risk to 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.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 6

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
01/03/2025 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20250103082700

FACILITY NAME:	SAVANT OF BURBANK WEST		FACILITY NUMBER:	198603137
ADMINISTRATOR:	VALDEZ, SILVIA		FACILITY TYPE:	740
ADDRESS:	1911 GRISMER AVE		TELEPHONE:	(818) 295-2727
CITY:	BURBANK	STATE: CA	ZIP CODE:	91504
CAPACITY:	100	CENSUS: 98	DATE:	10/15/2025
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Nancy Ruiz, Wellness Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff mismanaged resident's medication.
Staff did not ensure resident was kept clean.
Staff did not provide shower assistance to resident in care.
Resident's room was not kept clean by facility staff

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 31-AS-20250103082700

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 WEST	FACILITY NUMBER: 198603137
	VISIT DATE: 10/15/2025

NARRATIVE

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Staff mismanaged resident's medication.
It was reported that the client has been refusing medications at times. Facility staff attempt to administer medication up to three (3) times, and if the client continues to refuse, they discontinue further attempts. Concern was raised that Resident 1 (R1) may not be receiving prescribed medications, including PRNs, on a consistent schedule. On 01/10/2025, LPA conducted an interview with the Wellness Director (WD), who stated that R1 occasionally refuses medication and that, per policy, staff make three (3) attempts and notify R1’s physician and family of refusals. Additional interviews with the Executive Director (ED) and two (2) MedTechs on 09/30/2025 confirmed that staff follow the facility’s medication policy and procedures when a resident refuses medication. LPA reviewed R1’s Centrally Stored Medication Record (CSMR) and Medication Administration Record (MAR), which showed refusals were accurately documented and that notifications to R1’s physician and family were made. Facility medication policy specifies that staff are trained to make multiple attempts and record all refusals. R1 was also interviewed and confirmed that staff consistently offer medications multiple times before documenting refusals.
Based on interviews, record review, and policy examination, there is insufficient evidence to support the allegation that staff mismanaged R1’s medication. Documentation shows staff followed policy and communicated refusals appropriately. Therefore, the allegation is deemed unsubstantiated at this time.

Staff did not ensure resident was kept clean
It was reported that Resident 1 (R1) was not being properly cleaned during incontinence care, with fecal matter observed on their person. To investigate, LPA conducted interviews and reviewed facility records.
Interview with WD denied the allegation, stating that residents, including R1, are checked every two (2) hours or as needed for incontinence care. WD further reported that R1 occasionally refuses care. Furthermore, LPA observed that the facility internal notes documented R1 refused incontinence care on 12/21/2024 at 6:40 AM and again at 3:00 PM. Moreover, during the initial visit, R1 was observed to be clean, well-groomed, and free of odor. R1 reported that their incontinence needs are met and that they had no concerns. R1’s Physician’s Report confirmed R1 is incontinent but able to communicate needs. Lastly, All other residents interviewed confirmed they receive proper incontinence care and are changed as needed. Therefore, based on interviews, observations, and record review, there is insufficient evidence to support the allegation. Therefore, the allegation that staff did not ensure R1 was kept clean is deemed Unsubstantiated at this time.

Continue on LIC 9099C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250103082700

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 WEST	FACILITY NUMBER: 198603137
	VISIT DATE: 10/15/2025

NARRATIVE

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Staff did not provide shower assistance to resident in care.

It was reported that Resident 1 (R1) had not been receiving regular showers and subsequently developed cradle cap on their scalp. To investigate this allegation, LPA conducted interviews and observations. Interview with WD denied the allegation and stated that all residents, including R1, are provided with shower assistance at least two (2) times a week or as needed. Moreover, during the initial visit, R1 informed LPA that they are receiving assistance with showers and expressed no concerns. R1 was observed to be clean, well-groomed, and free of odor. Lastly, nine (9) out of nine (9) residents interviewed stated they receive proper care, including showers, and voiced no concerns related to the allegation.

Based on interviews and observations, there is insufficient evidence to support the allegation. Therefore, the allegation that staff did not provide shower assistance to R1 is deemed Unsubstantiated at this time.

Resident's room was not kept clean by facility staff.

It was alleged that urine was present at the bottom of the toilet and that the resident’s room was unsanitary. It was further alleged that food debris and crumbs were observed underneath the bed.To investigate these allegations, On 09/10/2025, LPA conducted interview with WD and on 09/30/25 with Executive Director (ED), and Maintenance Director (MD). All parties interviewed denied the allegations and stated that the facility conducts daily tidy-ups lasting approximately fifteen (15) minutes and weekly deep cleanings lasting approximately forty (40) minutes for all residents’ rooms. Furthermore, LPA was informed that R1’s room received additional cleaning services due to R1’s roommate exhibiting poor hygiene and at the request of R1’s family. These additional services were provided at no extra cost to R1.

Moreover, LPA reviewed the facility’s housekeeping schedule and observed that the facility employs three (3) housekeepers responsible for performing weekly deep cleaning of fifty (50) resident rooms. During the initial visit, LPA conducted a physical plant tour and observed that all rooms, including R1’s room and bathroom, were clean and free of food debris and crumbs. Lastly, interviews conducted with nine (9) out of nine (9) residents revealed no concerns regarding room cleanliness. All residents interviewed confirmed that their rooms are cleaned daily or as needed.

Based on the information obtained during the investigation, including staff and resident interviews and a review of facility records, there is insufficient evidence to support the allegation that the facility failed to maintain a clean and sanitary environment. Therefore, the allegation is deemed unsubstantiated at this time.

Exit interview conducted and copy this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250103082700

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 WEST	FACILITY NUMBER: 198603137
	VISIT DATE: 10/15/2025

NARRATIVE

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Staff did not prevent residents from engaging in inappropriate interactions.
It was reported that two residents were engaging in inappropriate interactions with each other in the lunch area of the facility. To investigate this allegation, LPA conducted an interview with the Wellness Director (WD), who admitted that on 01/01/2025, between approximately 2:00 PM and 3:00 PM, two (2) residents were observed engaging in an inappropriate interaction in the lunch area in the presence of other residents and visitors. The receptionist was notified by a witness and intervened to separate the residents. However, the receptionist did not move the residents far enough apart, resulting in the residents engaging in another inappropriate interaction shortly thereafter.

On 09/29/2025, LPA conducted telephonic interviews with the Executive Director (ED) and the receptionist. Both confirmed the information provided by WD and reported that no staff were assigned to provide care and supervision in the lunch area between 2:00 PM and 3:00 PM, as that time was outside of regular meal service hours. Based on information obtained through interviews, there was insufficient staff supervision at the time of the incident, which resulted in residents engaging in inappropriate interactions. Therefore, this allegation is Substantiated.

Deficiency issued and appeal rights explained.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

LIC9099 (FAS) - (06/04)

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