Savant Of Burbank West

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. UnsubstantiRead the full finding— CDSS inspection report, December 18, 2024 · control 31-AS-20241211152351

At 10:30am Licensing Program Analyst (LPA) Antonia Alvizar- Ettima conducted an unannounced subsequent visit to deliver the finding for the above noted allegations. LPA met with the Wellness Director, Lorena Del Luna and explained the reason for the visit. During initial visit on 05/31/2024 at 9:30a.m. LPA requested and received copies of the facility resident and staff roster. About 9:45a.m. LPA and Executive Director (ED) conducted a physical plant walk-through. Between 10:15a.m. and 12:30p.m. LPA interviewed, ED., Laundry staff, eight (8) out of eighty-nine (89) residents, one (1) staff that provides care to R1 and attempt to interview resident (R1) in their room but unsuccessful. At 12:36p.m. LPA conducted phone interview with additional witnesses. During interviews, LPA asked questions relevant to the nature of the complaint. At 1:30p.m. LPA obtained R1's facility records included but not limited to Identification Information, Physician’s Report, Physician’s Continue LIC 9099- C URead the full finding— CDSS inspection report, December 11, 2024 · control 31-AS-20240530130158

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to this facility to investigate the above allegations. LPA met with Executive Director, Silvia Valdez, and explained the reason for the visit. --- Staff are not providing resident with oxygen resulting in hospitalization. It was alleged that caregivers are unable to provide oxygen to Resident #1 (R1) due to scope of practice limits resulting in hospitalization. To investigate the allegation, at around 11:00a.m., LPA requested pertinent documents and interviewed staff from 11:30a.m. to 12:30p.m. A review of R1’s hospice services and facility Hospital Log revealed that Resident #1 (R1) was put on oxygen after initiation of hospice services on 11/14/2024 and has not been hospitalized since for lack of oxygen or otherwise. (CONT. on LIC9099-C) UnsubstantiatedRead the full finding— CDSS inspection report, November 20, 2024 · control 31-AS-20241118083437

Licensing Program Analyst (LPAs) Gary Tan and Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPAs met with the Wellness Coordinator, Emily Caluag, and advised her of the complaint. Today's investigation consisted of interviews, record review, and a physical plant inspection to insure facility compliance. Interview with the Wellness Coordinator reveal that Resident 1 (R1) does not reside at this facility, but at their other facility, Savant of Burbank East #198603136, which is located across the street (1900 GRISMER AVE). LPAs obtained a copy of the resident roster for this facility, and R1 was not listed. LPAs conducted a record review for Savant of Burbank East, to confirm R1 resided there. Based on the information gathered, the above allegations are deemed unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. Therefore, the complaint allegation is being dismissed. UnfoundedRead the full finding— CDSS inspection report, November 6, 2024 · control 31-AS-20241030100418

At 1:30PM Licensing Program Analyst (LPA) Antonia Alvizar- Ettima conducted an unannounced subsequent visit to complete an investigation and deliver findings of the above noted allegations. LPA met with De Luna and explained the reason for the visit. At approximately 1:55PM Silvia Valdez joined us. During initial visit on 09/08/2023 at 12:05p.m. LPA Alvizar-Ettima requested copies of the facility resident and staff roster. LPA and the Administrator conducted a physical plant walk-through, at approximately 12:20PM. LPA did not observe any immediate health and safety issues during the inspection. At 12:35PM LPA requested and obtained resident R1 Identification and Emergency Information, Physician’s Report, Physician’s Order, Preplacement Appraisal Information, Individual Service Plan, and Medication Administration Records (MARs). Prior to this visit on 10/22/2024 LPA Antonia Alvizar-Ettima reviewed the available records, including incident Continue on LIC 9099c UnsubstantiatedRead the full finding— CDSS inspection report, October 23, 2024 · control 31-AS-20230901160257

This is the amended copy of report previously issued to the facility. At 9:45a.m. Licensing Program Analyst (LPA) Antonia Alvizar- Ettima conducted an unannounced initial visit and was greeted by the Wellness Coordinator(WC). At 10:40a.m. the Executive Director (ED) arrived to the facility and LPA explained the reason for the visit. Prior to this visit on 02/27/24, LPA spoke with ED regarding the incident involving R1, at which time. LPA requested facility file of the resident #1 (R1), including physician report, need and service plan, hospice records and copies of an incident and death reports. At the time of this visit LPA Alvizar- Ettima requested residents and staff roster and facility internal log/notes. At 10:30a.m LPA and Wellness Coordinator conducted a physical plant tour. At 10:50a.m. LPA obtained contact information of the nurses from the hospice company assisting R1. Between 11:00a.m. – 12:00p.m. LPA contacted via-phone Comfort Life Hospice and interviewed two (2) witnessesRead the full finding— CDSS inspection report, March 8, 2024 · control 31-AS-20240228160422

Licensing Program Analyst (LPA) Angelica Rea conducted a subsequent visit in response to the above allegation. On today's visit, LPA met Executive Director, Silvia Valdez, who assisted with the visit. Regarding the allegation: Facility staff did not provide adequate care to resident #1. The investigation consisted of interviews with Executive Director, Staff #1 - Staff #3, Resident #1, and review of resident #1's file. The investigation revealed that on 4/28/2022, facility staff called 911 due to resident #1 being unresponsive. Resident #1 was admitted to hospital, was discharged, and returned to the facility on 5/1/22. Executive Director and staff interviewed stated that the facility is providing adequate care to resident #1. They stated that the incident occurred due to resident #1's blood glucose level being low. Facility staff indicated that resident #1's glucose was being checked daily by home health. LPA observed resident #1 blood sugar records for May 2022, and observed that itRead the full finding— CDSS inspection report, August 8, 2023 · control 28-AS-20220502130402

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to investigate the above allegation. LPA met with the Community Ambassador, Silvia Valdez, and explained the reason for the visit. ---Staff is financially abusing resident in care. It was alleged that facility is not issuing Resident #1’s (R1) $168.00 and month personal and incidental needs money (P&I) from Social Security. To investigate the allegation on 02/15/2023 LPA requested documents at around 2:00 PM and interviewed two (02) staff between 02:30 PM to 3:15 PM. Record review shows that R1's checking account is controlled by the power of attorney (POA). Records also show that POA gave facility authoization to debit up to $1,300.00 per month and facilty is withdrawing $1,231.77 per month to pay for R1's rent expense only. (CONT. on LIC 9099-C) UnsubstantiatedRead the full finding— CDSS inspection report, March 27, 2023 · control 28-AS-20230209165846

On 10/20/22 Licensing Program Analyst (LPA) Ashley Calderon visited the above facility unannounced, to conduct a subsequent visit on a complaint investigation for the allegation listed above. LPA Calderon met with Business Manager Harlyn Onsik. On 1/7/21, LPA Long conducted a initial complaint via telephonically. LPA Long interviewed Administrator Adam Zenou and requested a copy of the following documents: Staff/Resident roster, Resident #1's (R1) latest and prior: Physician Report, Needs and Services Plan, Pre-Apprasial, Admission Agreement,Medical Administration Records(MARS), Hospital/Doctor's appointment records, Power of Attorney/Responsible Party and Weight Chart. Todays complaint investigation consisted of, LPA Calderon reviewing R1's Hospice Admission Documentation, Care Plan and Discharge Notes.In addition, R1's Facesheets,Admission Agreement, Controlled Substance Inventory, Progress Notes - Carelist, doctors reports, weight assessment chart, Emergency Information and MARS forRead the full finding— CDSS inspection report, October 20, 2022 · control 28-AS-20201231082101

**** This amended report supersedes report dated 09/16/2022. It was created to add additional information to support 1st allegation finding that was gathered from subsequent interview with facility staff Silvia Valdez. The additional revision did not change any other aspects of the report and all aspects including the findings remain the same.*** Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced subsequent complaint visit in response to the above allegations. LPA met with Silvia Valdez Community Ambassador, who assisted with today's visit. Initial visit was on 07/07/2022 During initial visit visit, LPA interviewed Administrator S5 and Staff #1-4, LPA requested and obtained copies of specific documents from Resident #1's file, R1 D/C order, R1 functional capability assessment, Preplacement Appraisal Information, , SIR dated 6/27/22, 6/28/2022 6/29/22, R1 Physician’s report for residential care facilities for the elderly (RCFE) R1 Admission record, face sheet and PhyRead the full finding— CDSS inspection report, September 16, 2022 · control 28-AS-20220705112304

Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by Staff #4 (S4): Emily Caluag, Receptionist; as Administrator (A1: Adam Zenou) was unavailable; therefore, LPA/RA met with Staff #5 (S5): Silvia Valdez, Community Ambassador/Marketing Director. LPA/RA spoke to S4 prior to entering the facility to conduct a risk assessment. S4 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 deliver the findings pertaining to the above-mentioned allegations. The initial 10-Day virtual visit was conducted by LPA Joe Katrdzhyan on 01/11/21 (via telephone) with Staff #1 (S1): Office Manager, Marili Barajas due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures. LPA/RA Ceniceros interviewed (between 9:30 a.m. - 10:30 a.m.) three (3) additional staff members. Resident #1 was not inteRead the full finding— CDSS inspection report, September 7, 2022 · control 28-AS-20201230133738

Licensing Program Analyst (LPA) David Sicairos conducted a subsequent complaint visit to deliver investigation findings for the above stated allegation. LPA met with Executive Director Adam Zenou and explained the reason for the visit. Investigation consisted of the following: during the initial televisit conducted on 10/22/20, LPA interviewed the former Administrator and obtained copies of Resident and Staff Rosters. During today's visit, LPA interviewed the Executive Director and obtained copies of Resident & Staff Rosters. Investigation revealed the following: during today's interview with the Executive Director, it was confirmed that Resident #1 (R1) was never a resident of this facility. R1 was a former resident of the sister facility associated to this facility. This was verified by reviewing the "Customer Quick Report" which lists the sister facility address for R1. R1 is also not listed in the current facility roster. (CONTINUED ON 9099C) UnfoundedRead the full finding— CDSS inspection report, June 21, 2022 · control 28-AS-20201016114516