Savant Of Burbank East

Licensing Program Analyst (LPA) Tuesday Cabiness met with Executive Director (ED) Nirjara Acharya and informed her the reason of the visit. From 1pm to 230pm LPA interviewed the ED and conducted a physical inspection of random resident's and employee bathrooms, on the first and second floor. Hot water ranged from temperatures of 105.8, 107.6, 110.6, and 111.2, which is in compliance with Licensing regulations. Although, the ED confirmed the hot water was out, a repair company, came the same day, and attempted to fix the boiler. The boiler needed a part, which was ordered and the boiler was fixed a day later. The ED, submitted an incident report, and all residents were notified that the hot water was not operable, but would be fixed. Therefore, based on physical plant inspection, and documentation received, the allegation is Unsubstantiated at this time. UnsubstantiatedRead the full finding— CDSS inspection report, March 3, 2023 · control 28-AS-20230227090159

**** This amended report supersedes report dated 02/24/2023. It was created to remove identifiling information from origianal 9099 and 9099C report and add additional response from staff. The additional revision did not change any other aspects of the report and all aspects including the findings remain the same.*** LPAs Alberto Lopez and Erik Zaragoza made subsequent unannounced visit to investigate the above allegations. LPAs met with Office Manager Marili Barajas and explained the purpose of the visit. The investigation consisted of interviews with staff #1-#6 (S1-S6) and residents #1-#9 (R1-R9). LPAs reviewed and obtained staff and residents’ rosters, R10 Physicians report dated 10/20/2021 and preplacement appraisal. R10 inventory of personal effects dated 9/25/2020. R10 refused to fill out but signed the form. Residents’ departure inventory list dated 11/23/2022. (Continued on 9099C) UnsubstantiatedRead the full finding— CDSS inspection report, February 24, 2023 · control 28-AS-20221212130852

Licensing Program Analyst (LPA) Tihesha Smith made an unannounced complaint visit to this facility at 11:37 am to investigate the above allegations. LPA met with the administrator and disclosed the reason for the visit. LPA conducted interviews with the administrator, seven (7) staff members and ten (10) out of ten (10) residents between 11:50am – 3:30pm. In addition, LPA reviewed facility records from 2:20pm to 3:15pm and obtained copies of pertinent documents relevant to the investigation. LPA conducted a physical plant tour at approximately 12:30 pm to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. LPA did not observe any immediate health and safety issues during the visit. Facility staff does not ensure that resident receive food on a timely basis. During the physical plant tour, LPA observed residents in dining room and in their bedrooms eating UnsubstantiatedRead the full finding— CDSS inspection report, January 26, 2023 · control 28-AS-20230125085608

At approximately, 10:00am Licensing Program Analyst (LPA), Angela Panushkina arrived to this facility in response to the above mentioned allegation. LPA met with the Office Manager and explained the reason for the visit. LPA conducted a physical plant walk through, at approximately 10:30am, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. LPA did not observe any immediate health and safety issues during the visit. LPA conducted interviews with the Office Manager, MedTech, two (2) staff members and ten (10) out of eleven (11) residents between 10:30am - 12:50pm. In addition, LPA reviewed facility records from 1:00pm to 2:00pm and obtained copies of pertinent documents relevant to the investigation. Continue on LIC9099-C UnsubstantiatedRead the full finding— CDSS inspection report, January 18, 2023 · control 28-AS-20230113122750

At approximately, 10:00am Licensing Program Analyst (LPA), Angela Panushkina arrived to this facility in response to the above mentioned allegation. LPA met with the Administrator and explained the reason for the visit. LPA conducted a physical plant walk through, at approximately 10:30am, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. LPA did not observe any immediate health and safety issues during the visit. LPA conducted an interview with the Office Manager, MedTech, two (2) staff members, ten (10) out of eleven (11) residents between 10:30am - 12:50pm. In addition, LPA reviewed facility records from 1:00pm to 2:00pm and obtained copies of pertinent documents relevant to the investigation. Continue on LIC9099-C UnsubstantiatedRead the full finding— CDSS inspection report, January 18, 2023 · control 28-AS-20230113145359

Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Marili Barajas Business Manager and explained the reason for the visit. Shortly thereafter Administrator Nirjara Acharya arrived. The investigation consisted of the following: LPA requested staff/resident roster. LPA interviewed resident #1(R1),#2(R2),#3(R3),#4(R4),#5(R5), and #6 (R6) from 1:30 PM to 2:30 PM. LPA interviewed Marili Barajas Business Manager at 1:15 PM and Administrator at 3:00 PM. The investigation revealed the following: Regarding allegation: Based on interviews conducted and information gathered 6 of 6 residents interviewed stated they received over a month ago a letter from the facility regarding a cost of living increase. Stated they received it in a timely manner. 5 of 6 residents stated they understood that SSA and SSI would be increased and why in turn their rent would increase. Staff interviewed stated that a letter waRead the full finding— CDSS inspection report, December 19, 2022 · control 28-AS-20221209154741

Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint investigation for the allegations listed above. The purpose of the visit was explained to Office Manager Marili Barajas. Administrator Nirjana Acharya arrived shortly after and assisted with today's visit. The investigation consisted of the following: On 7/29/20, due to COVID-19 pandemic a virtual physical plant inspection of resident rooms was conducted via FaceTime between 3:07 pm – 3:49 pm. LPA observed rooms 102, 115, 123, 124, 125, 203, 215, 216, 220, and 245. Staff (S1- S3), and residents (R1- R2) were interviewed. On 8/12/2020, LPA interviewed residents (R3-R10) and staff (S4-S6) telephonically, and visually inspected rooms 217, 218, 220, & 221 via FaceTime. 8/13/2020. The following documents were obtained: Identification and Emergency Information/Face Sheet, Admission Record, physician order (7/20/20), POLST, Preplacement Appraisal Information, Admission Agreement, Shower Assignment, and MD Visit report. DRead the full finding— CDSS inspection report, December 1, 2022 · control 28-AS-20200723145406

Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint investigation for the allegations listed above. The purpose of the visit was explained to Office Manager Marili Barajas. Administrator Nirjana Acharya arrived shortly after and assisted with today's visit. The investigation consisted of the following: On 7/29/20, due to COVID-19 pandemic a virtual physical plant inspection of resident rooms was conducted via FaceTime between 3:07 pm – 3:49 pm. LPA observed rooms 102, 115, 123, 124, 125, 203, 215, 216, 220, and 245. Staff (S1- S3), and residents (R1- R2) were interviewed. On 8/12/2020, LPA interviewed residents (R3-R10) and staff (S4-S6) telephonically, and visually inspected rooms 217, 218, 220, & 221 via FaceTime. 8/13/2020. The following documents were obtained: Identification and Emergency Information/Face Sheet, Admission Record, physician order (7/20/20), POLST, Preplacement Appraisal Information, Admission Agreement, Shower Assignment, and MD Visit report. DRead the full finding— CDSS inspection report, December 1, 2022 · control 28-AS-20200723145406

**** This amended report supersedes report dated 11/18/2022. It was created to add additional resident information and new staff responses to questions to support the first 3 allegation findings and to correct resident # from R1 to R2 on allgation #1 The additional revision did not change any other aspects of the report and all aspects including the findings remain the same.*** Licensing Program Analyst(s) (LPA) Alberto Lopez conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA met with Administrator NIrjara Acyarya and explained the reason for the visit. On Subsequent visit on 03/06/2023 LPA met with Office Manager Marili Barajas and expalined pupose of visit. The investigation consisted of the following: LPA requested the following documents: physician's report, for #1(R1) and #2(R2) and personnel and staff rosters. LPA interviewed resident #1(R1), #2(R2),#3(R3),#4(R4),#5(R5),#6(R6),#7(R7),#8(R8),#9(R9) Administrator and staff #1(S1),#2(S2)#3(Read the full finding— CDSS inspection report, November 18, 2022 · control 28-AS-20221117125637

Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by Staff #1 (S1: Marili Barajas, Office Manager). LPA/RA Ceniceros spoke to S1 prior to entering the facility to conduct a risk assessment. S1 informed LPA/RA that the facility has no COVID cases nor do any of the residents or staff have symptoms. The purpose of today’s visit is to conduct a subsequent visit to deliver the findings pertaining to the above-mentioned allegation. An initial 10-Day virtual visit was conducted by LPA Nicol Wesley on 01/13/21 (via telephone) with S1 due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures. LPA/RA Ceniceros interviewed (between 8:15 a.m. - 9:00 a.m.) facility staff member and residents in care (R2-R3). Resident #1 was not interviewed; as the resident moved out of the facility on 12/29/20. LPA/RA Ceniceros reviewed pertinent documents (between 9:00 a.m. – 9:45Read the full finding— CDSS inspection report, October 13, 2022 · control 28-AS-20210104085209

Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by Staff #1 (S1: Marili Barajas, Office Manager). LPA/RA Ceniceros spoke to S1 prior to entering the facility to conduct a risk assessment. S1 informed LPA/RA that the facility has no COVID cases nor do any of the residents or staff have symptoms. The purpose of today’s visit is to conduct a subsequent visit to deliver the findings pertaining to the above-mentioned allegations. An initial 10-Day virtual visit was conducted by LPA Glenn Trueman on 04/22/21 (via telephone) with S1 due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures. LPA/RA Ceniceros interviewed two facility staff members (S1 & S5) and five residents in care (R2-R6). LPA/RA did not interview the following staff for the reasons noted: Staff #2 (Caregiver - resigned: 06/04/21), Staff #3 (Med Tech/Caregiver - resigned: 12/20/21)), StaffRead the full finding— CDSS inspection report, October 13, 2022 · control 28-AS-20210416113753

This report supersedes the one dated 09/01/2022 to include additional information. Licensing Program Analyst (LPA) Glenn Trueman made a subsequent visit for the allegations listed above. LPA met with Office Manger Marili Barajas and Administrator Nirjara Acharya. At initial visit 08/19/2021 the following occurred: The investigation consisted of the following: Interviews with Administrator, and Staff S1-S 3 from 9:15 AM to 11:00 AM. LPA Trueman requested Physician's Report, Needs and Services Plan, Emergency ID page and Hospice Documentation from Resident 1's file. At today's visit 09/01/2022 from 1:15 PM to 3:00 PM Resident's 1-8 were interviewed. In regards to Resident sustained pressure injuries while in care, Documentation from Hospice Agency for Resident R1 specifies Physician's Order start date 08/10/2021 and stop date 09/08/2021 L ankle wound and to cleanse with NS pat dry and cover with gauze every 2 to 3 days as needed. Documentation titled Skin Impairment Assessment from HospiRead the full finding— CDSS inspection report, October 12, 2022 · control 28-AS-20210818102537

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA met with Marili Barajas Business Manager and explained the reason for the visit. The investigation consisted of the following: LPA requested staff/resident roster. LPA interviewed resident #1(R1),#2(R2),#3(R3),#4(R4),#5(R5),#6(R6),#7(R7),#8(R8),#9(R9) and staff #1(S1),#2(S2)#3(S3),#4(S4),#5(S5). LPA requested the following documents; physician's report, admission agreement, unusual incident report, face sheet, emergency and identification information, preplacement appraissal, and hospital discharge documents for resident #1(R1). The investigation revealed the following: Regarding allegation: Staff did not address an open sore on resident's buttock in a timely manner. It is alleged that caregiver changing R1 noticed an open sore on right buttocks, notify the Technician about the sore, and nobody followed up with R1. Interviews with residents revealRead the full finding— CDSS inspection report, October 11, 2022 · control 28-AS-20221005131717

Licensing Program Analyst (LPA) Glenn Trueman made a subsequent visit for the allegations listed above. LPA met with Office Manger Marili Barajas and Administrator Nirjara Acharya. At initial visit 08/19/2021 the following occurred: The investigation consisted of the following: Interviews with Administrator, and Staff S1-S 3 from 9:15 AM to 11:00 AM. LPA Trueman requested Physician's Report, Needs and Services Plan, Emergency ID page and Hospice Documentation from Resident 1's file. At today's visit 09/01/2022 from 1:15 PM to 3:00 PM Resident's 1-8 were interviewed. In regards to Resident sustained pressure injuries while in care, Documentation from Hospice Agency for Resident R1 specifies Physician's Order start date 08/10/2021 and stop date 09/08/2021 L ankle wound and to cleanse with NS pat dry and cover with gauze every 2 to 3 days as needed. Documentation titled Skin Impairment Assessment from Hospice Agency dated 09/09/2021 stated that R1 has existing treatment for left ankle wouRead the full finding— CDSS inspection report, September 1, 2022 · control 28-AS-20210818102537

Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit regarding the above stated allegation. LPA met with the Administrator Nirjara Acharya and explained the reason for the visit. The investigation consisted of the following: LPA obtained copies of Staff & Resident Rosters. LPA toured the facility including common areas and smoking area. LPA also interviewed the Administrator, Staff #1 - Staff # 3, and Resident #1 - Resident #9. The investigation consisted of the following: in regards to the allegation "residents are being exposed to cigarette smoke while in care", it is alleged that residents smoke too closely to the main entrance door which causes the smoke to enter the lobby where other residents are then exposed to the cigarette smoke. LPA toured the main entrance/smoking area of the facility and observed several residents smoking in the designated smoking area which is located near the main entrance of the building. Staff members interviewed indicRead the full finding— CDSS inspection report, June 21, 2022 · control 28-AS-20220614102941

Licensing Program Analyst (LPA) Lopez conducted a complaint visit to investigate the allegation listed above. LPA met with Manager Marili Barajas and explained the reason for the visit. The investigation consisted of the following: Interviewed resident #1-9 (R1), Manager and five facility staff (S#1-S#5 were interviewed. LPA obtained resident and staff roster, SIR dated 5/08/22, 7 elevator repair invoices dated 09/17/21, 10/13/21, 12/03/21, 12/07/21, 03/02/22, 05/08/22, and 5/12/22, no elevator repair logs are kept by facilty and fax transmittal for 05/08/22 SIR Allegation: Resident was stuck in facility elevator Manager and 4/5 staff and 7/9 residents collaborated allegation that resident was stuck in elevator on 5/08/22 LPA tested elevator and it moved up and down properly, However, phone was not functioning and it was not known how long it has been in disrepair. Based on information and documentation received allegation is SUBSTANTIATED (continued on 9099C) SubstantiatedRead the full finding— CDSS inspection report, May 20, 2022 · control 28-AS-20220512163229

On 04/29/2022 (11:00 AM), Licensing Program Analyst (LPA) Gail Johnson arrived at Burbank Senior Villa East, formerly named Le Bleu Chateau and conducted an unannounced subsequent complaint visit. LPA met with Manager Marili Barajas. LPA Johnson explained the purpose of today’s visit. Investigation consisted of the following: LPA reviewed and obtained the following documents: 30 day notice and fax receipt to CCL, rent payment invoices, R1 Resident Departure Form, Admission Agreement, County of Los Angeles Sheriff’s Department Receipt for Possession of Real Property (May 3, 2021), R1 Face Sheet, and R1 Physician’s report. LPA conducted interviews with House Manager Marili Barajas and R1. Conitnued on LIC-9099C UnsubstantiatedRead the full finding— CDSS inspection report, April 29, 2022 · control 28-AS-20210416101629

Licensing Program Analyst (LPA) Vasallo conducted a subsequent complaint visit to investigate the allegation listed above. The initial complaint visit was conducted on 12/15/21. Licensee, Adam Zenou assisted with that visit. The investigation consisted of the following: During the initial visit, Resident #1's (R1) file was reviewed. Interviews were conducted with the Licensee and Business Office Manager. R1 is no longer a resident of the facility and therefore was not interviewed at the time. On 1/19/22, LPA discovered R1's whereabouts and R1 was interviewed. Also on 1/19/22, LPA contacted an investigator from the Social Security office to inquire about R1's social security funds. During today's subsequent visit, 7 residents were interviewed. The investigation revealed the following: It's alleged facility stole R1's social security money and stimulus checks. Facility was the payee for R1's social security funds. Facility records indicate R1 would receive money from facility staff whenRead the full finding— CDSS inspection report, March 16, 2022 · control 28-AS-20211215131442

Licensing Program Analyst (LPA) Vasallo conducted a complaint visit to investigate the allegation listed above. LPA met with Licensee, Adam Zenou and explained the reason for the visit. The investigation consisted of the following: Resident #1 (R1) and two facility staff were interviewed. R1's file was reviewed including R1's admission agreement. The investigation revealed the following: It's alleged R1 was not provided a refund after moving out of the facility on 10/17/21. Allegedly R1 was verbally told he/she would receive a refund since R1 paid the rent for October 2021. R1 was interviewed and indicated that he/she did not provide the facility with a 30-day notice, but insisted that Staff #1 (S1) verbally promised a pro-rated refund from 10/18/21 - 10/31/21. S1 was interviewed and indicated he/she did not promise a refund. R1's admission agreement dated 5/1/20 states residents are required to provide a 30 day advance notice of intent to move. Continued on 9099C. UnsubstantiatedRead the full finding— CDSS inspection report, December 13, 2021 · control 28-AS-20211203111612

Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPA met with Office Manager / Marili Barajas and was later joined by the Administrator / William "Bill" Boles who assisted with the visit. LPA Katrdzhyan explained the purpose of today’s visit is to discuss the above mentioned allegation of "Suspicious death". During today's visit, LPA conducted interviews of various persons to include the Office Manager, Administrator, CEO / Adam Zenou and Residents 1 - 4 (R1 - R4). The investigation revealed the following; The details of this allegation stated that there was a suspicious death / murder in the facility. Based on interviews conducted, LPA discovered that there has been no such incident of a suspicious death or a murder at Burbank Retirement Villa East. Statements obtained were consistent and stated that the incident UnfoundedRead the full finding— CDSS inspection report, October 19, 2021 · control 28-AS-20211018141120

Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial 10-day investigation visit. LPA met with S-1 and discussed the purpose of today's visit. Facility Administrator (S-3) arrived at approximately 10 A.M.. During today's visit, LPA obtained the staff roster, resident roster, interviewed Staff #1 through Staff #4 (S-1 through S-4), interviewed Resident #1 through Resident #6 (R-1 through R-6) and obtained relevant documentation. Refer to LIC 9099C for the contination of this report. Unsubstantiated— CDSS inspection report, October 18, 2021 · control 28-AS-20211012134559

Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint visit to this facility. The purpose of the visit was to gather information regarding the allegations and to complete the investigation. LPA met with Marili Barajas (House Manager) and explained the reason for the visit. During the initial visit conducted on 01/03/20, LPA obtained/reviewed a copy of the Staff/Resident roster, medication logs for Resident #1 through #7, interviewed Staff #1 in the staff dining room at 9:46 am, toured the facility at 11:03 am with Staff #1 and interviewed Resident #1 through #4 in the staff dining room between 11:28 am to 1:54 pm. During today's visit, LPA obtained a copy of the Staff schedule, Resident roster and food menu. LPA interviewed Resident #5 to #9 between 10:20 am to 11:30 am in the conference room, interviewed Staff #2 in the conference room at 11: 35 am and took a tour of the facility with Staff #2 at 11:45 am and interviewed Staff #3, #4, #5 and #6 in the conferenceRead the full finding— CDSS inspection report, October 1, 2021 · control 28-AS-20191226095848

Liceising Program Analyst (LPA) Elizabeth Irra conducted an unannounced 10-day initial investigation for the above allegations. LPA met with Facility Administrator and discussed the purpose of today's visit. During today's visit, LPA obtained the Resident and Staff rosters,interviewed Staff #1 (S-1) through Staff #4 (S-4), interviewed Resident #1 (R-1) through Resident #6 (R-6) and obtained relevant documentation. Refer to LIC 9099C for the continuation of this report. Unsubstantiated— CDSS inspection report, September 20, 2021 · control 28-AS-20210914102641

Licensing Program Analyst (LPA) Angelica Rea conducted another visit to issue the final results of the investigation. LPA met with Administrator, William Boles who assisted with today's visit. Regarding the allegation that a former residents wheelchair was damaged while in care and staff did not provide necessary accomodations for resident in care, the investigation consisted of interviews with Administrator, Staff #1 and Resident #1 - Resident #6. Administrator and Staff #1 stated that they were not aware that former resident's wheelchair was damaged while in care. They stated that it was not brought to their attention. Administrator and Staff #1 stated that staff do provide necessary accomodations for residents in care. LPA interviewed 6 Residents who use wheelchair(s). 5 out of 6 residents stated that they have no trouble with the accomodations provided, and have no trouble maneuvering their wheelchair(s) at the facilty. 6 out of 6 residents stated that their wheelchair has not beenRead the full finding— CDSS inspection report, August 25, 2021 · control 28-AS-20210730123119

An unannounced subsequent complaint visit was conducted on this day by Licensing Program Analyst (LPA)Wendell Smith . Upon arrival LPA met with administrator Bill Boles and explained the reason for this visit. Regarding the allegation listed above it is being alleged that the Licensee/Administrator stole resident 1 (R1's) identity, opened a bank account under his name and that his social security Income SSI is being deposited into this new account. Additionally, it is being alleged that administrator stole a money order from R1 in the amount of $500.00. Initial 10-day complaint visit was conducted on 5/13/2020 by LPA Yelena Avetisyan. During the visit LPA Avetisyan conducted interview with the administrator and requested document to be submitted related to the allegation listed above. Additionally, on 5/15/2020 LPA Avetisyan conducted interview with Resident 1 (R1). UnsubstantiatedRead the full finding— CDSS inspection report, July 16, 2021 · control 31-AS-20200508134915