Burbank Hills Residential Care Facility

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA), Nadia Shabazian, conducted an unannounced annual inspection at the facility mentioned above. LPA met with Dominor Viernes-Caregiver and explained the reason for the visit. LPA spoke with Dina Alger - Administrator, over the telephone, who stated that she has a scheduled medical procedure and is unable to come. Administrator designated Dominor Viernes to sign the report. At approximately 1:20 pm, Administrator-Dina Alger entered the facility and met with LPA. The facility is approved for six (6) non-ambulatory residents, all of whom may be bedridden. Facility's hospice approval was increased to total of six (6) residents. Current census is four (4). At 9:40 am, LPA conducted a physical tour, with the assistance of staff and observed the following: Required postings were observed in the living room and dining room walls. The smoke/carbon monoxide detectors are hardwired and interconnected. At 10:20 am, the smoke/carbon monoxide detectors were tested and functioned properly. There are five (5) fire extinguishers located in the kitchen, front entry, hallway, patio and in the converted garage. All the fire extinguishers were fully charged on 08/01/2024. Kitchen: Appliances consisted of stove, dishwasher, microwave and refrigerator. LPA checks all the appliances for cleanliness and observed them to be clean and operational. All knives and sharps observed to be locked in a kitchen drawer and chemicals were locked underneath the sink, inaccessible to residents. The cabinets were supplied with plenty of non-perishable foods, for minimum of 1 week; and refrigerator was supplied with perishable foods for 2 days. There were plenty of dishes maintained in the kitchen cabinets. Thee kitchen has a door, leading to the laundry room. LPA observed laundry detergents and chemicals in locked cabinets. The laundry machines included one washer and one dryer, which were in functional mode. There is an exit door in the laundry room, which leads to the backyard. Continued on 809-C Common Areas: According to the facility sketch, the common areas included a family room, the living room and dining room. Based on the sketch, the living room is located by the entry door; the dining room is near the kitchen and the family room is a large space, also next to the kitchen. LPA observed that the licensee has repurposed the facility living room as living quarters for the licensee and family. The dining room is currently being used as the office/music room. The large family room is being used currently as a dining room and living room. The common areas were properly furnished with sofas and dining room chairs and table, appropriate for number of residents. In addition, living room was furnished with book cases and cabinets for gaming/entertainment. There are three storage cabinets for linens and supplies, one in the living room and two in the hallway. Facility is equipped with cable, internet and land line and cameras in front and back/side yard areas. Bedrooms: There are three (3) bedrooms for resident use. All bedrooms are shared but currently bedroom #2 is used as a private bedroom. Bedroom #3 has an exit door, leading to the backyard. All bedrooms were clean, properly furnished with dresser drawers, closets, chairs with ample lighting and bedding for the residents. Bathrooms: There are three (3) bathrooms, one (1) designated for residents' use, one (1) for the staff and one half (1/2) bathroom in the backyard patio/garage area. Both bathrooms in the house were properly supplied with paper towels, tissues and hand soap, and had functional fixtures (grab bars and non-skit mats). Hot water temperature was measured at 112.4 degrees Fahrenheit. Surrounding Grounds: There is a covered patio with furniture appropriate for outdoor use, for the number of residents. The outdoor area was free of hazards. There are two side exits in the backyard, but facility uses the entry door as the main exit. There is no body of water present. The garage is currently being used as storage/sleeping quarter for staff. There is also a half (1/2) bathroom outside of the garage/staff room. (Continued on 809-C) Medications: LPA observed all medications and Medication Administration Records (MARs) in a locked kitchen cabinet. A complete First Aid kit and the First Aid Manual was also observed. Resident records: All records were observed as locked and inaccessible to residents. Records for four (4) out of four (4) residents were reviewed for resident rights, physician reports, admission agreements and additional documents. Resident records appeared to be complete and current. Staff records: All records were observed as locked in the office area. A total of three (3) staff files were reviewed. Criminal record clearances were present, and staff are associated to this facility. Staff records appear to be complete and current. The Administrator admitted that ever since the Covid-19 Pandemic, licensee has been using the living room as living quarters for the family, without submitting any plan of approval from CCLD or submitting updated sketches. In addition the garage is also being used as temporary staff room, without prior approval from CCLD. Licensee will obtain permits, current sketch and fire inspection report for the garage and converted living/diring rooms and will submit them to CCLD within 30 days. Based on initial Plan of Operations submitted, the licensee will ensure that there are sufficient number of staff scheduled to work all shifts. Based on Title 22 Regulation: A new Plan of Operations and LIC 500 (Personnel Report) shall be submitted to CCLD within thirty (30) days, to ensure sufficient staff coverage during a 24 hour shift. Deficiencies cited during today’s visit. Appeal rights issued and given. Exit interview conducted and a copy of this report was given to facility Administrator.the state’s words, verbatim · CDSS document, Jul 29, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan, met with Administrator Tina Dina Algar for a One (1) Year Required visit for this facility. LPA explained the reason for the visit. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation and Infection Plan. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room. A tour of the physical plant was conducted with the administrator at 3:25 PM. The facility is a single storey building with four (4) bedrooms two (2) bathrooms currently occupying four (4) residents. The facility is fire cleared for six (6) non-ambulatory residents, all of which may be bedridden. Hospice waiver for one (1) residents. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with dining The facility maintains a comfortable temperature at 74°F. The smoke detectors are hardwired and inter connected and observed to be operational. The fire extinguishers were filled and last bought on 12/06/23. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. The front and backyard passageways were clear of any obstruction. There is no body of water in the facility. The garage is detached to the home and currently being used as old equipment storage, tool shed and staff rest area. (continued on LIC 809-C) (continued from LIC 9099) Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning supplies including detergents and pesticides and other toxins are stored in locked cabinet under the sink. Knives and sharps are observed to be kept in a locked drawer in the kitchen. Laundry area is located adjacent to the kitchen on the way to the backyard. Laundry soap is locked on the cabinet above the laundry machine. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at 115.4°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the linen cabinet. Medications: LPA observed medication in a cabinet located in the kitchen to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. First aid kits have complete tools and supplies. Client records: Client records are reviewed and appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff record. Staff records appeared to be complete and updated. Disaster drill was last conducted on 06/29/2024. Required posting are observed to be complete and current and displayed properly at the facility. Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Jul 12, 2024

Allegation investigated: Staff took resident belongings. Facility has vermin. Staff not providing adequate food service. Licensee speak inappropriately to resident.

On 01/03/24 at 11:30 a.m. Licensing Program Analyst (LPA) Evelin Rios conducted a subsequent complaint visit to this facility to conclude the investigation regarding the above allegations. LPA was greeted by staff Janet Santiano, who called the administrator Dina Alger to inform them LPA was at the facility. LPA informed the administrator the purpose of the visit. Administrator was unable to meet LPA at the facility and designated Janet to sign todays report. During the course of the investigation, on 01/09/22, from 10:15 a.m. to 11:43 a.m. LPA Rios conducted interviews of four (4) out four (4) residents and three (3) out three (3) staff including the Administrator. From 11:04 a.m. to 11:43 a.m. LPA reviewed resident files and obtained copies of pertinent information. Allegation #1: Staff took resident belongings. In regards to the allegation is was reported, staff took several items from resident #1 (R1) had with them prior to moving into the facility. LPA's interview with staff and administrator on 01/09/22, denied the allegation. (Cont. on LIC 9099C) Unsubstantiated During physical plant tour LPA did not observe items mentioned in the complaint outside of other residents bedrooms. According to the administrator on 01/09/22. R1 denied to have their items inventoried. R1's admission agreement indicated they denied to have items inventoried. Based on the information obtained, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED at this time. Allegation #2: Facility has vermin. In regards to the allegation it was reported, there are roaches and spiders in the facility. LPA's interview with staff and administrator on 01/09/22, denied the allegation. During physical plant tour LPA did not observe roaches or spiders in the facility. Administrator informed LPA that at some point in the past prior to R1 moving in she had an exterminator work on the house but administrator could not provide a receipt or service performed by the exterminator. Based on the information obtained, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED at this time. Allegation #3: Staff not providing adequate food service. In regards to the allegation it was reported, there has been hair in R1's food several times while at the facility. LPA's interview with staff and administrator on 01/09/22, denied the allegation. During physical plant tour LPA observed staff prepare meals for residents for lunch and LPA observed staff wash their hands before handling food and the area where food was being prepared was clean and clear of clutter. LPA also observed residents eating their meals with no apprehension. Administrator informed LPA R1 mostly requested outside food and would refuse to eat meals prepared at the facility. According to the administrator they would comply and bring outside food for R1. Based on the information obtained, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED at this time. Allegation #4: Licensee speak inappropriately to resident. In regards to the allegation it was reported, licensee Dina, would raise her voice at R1 when they would complain about hair in their food. LPA's interview with staff and administrator on 01/09/22, denied the allegation and revealed R1 would yell at them. Based on the information obtained, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED at this time. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 3, 2024 · control 28-AS-20221230151413

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with licensee Dina Algar at 10:30am At 10:45 am, with the assistance of licensee, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are operational and their carbon monoxide detectors that functions properly. The fire extinguisher is in the hallway, kitchen, and common room and the charge date is 12/12/2023. During the visit the facility is at 71 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory. Kitchen: The kitchen is beside the common room. The kitchen is locked and only employees can enter the area. The kitchen appliances and fixtures were functional. The kitchen has a working electric stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. Cleaning supplies are being stored in a locked cabinet in the lock laundry room beside the kitchen. Properly labeled medications were locked in the kitchen area cabinets in the office station. Bedrooms: There were three (3) bedrooms designated for residents' use. Three (3) of the bedrooms, in use by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Room #1, room #2 and #3 are properly furnished and occupied by shared residents. There is only one (1) resident for room #1 and room #3 for now. There are one (1) staff bedroom and that is locked with no medication in sight. Continue to LIC 809-C Bathrooms: There are two (2) bathrooms in the facility, but only one (1) bathroom is designated for residents' use. The bathroom were properly supplied and had functional fixtures. Bathroom #1 hot water temperature was measured at 119.2 degrees Fahrenheit and bathroom #2 is for staff used. Bathroom #1 is for residents and is located in the hallway between bedroom #2 and bedroom #3 is located in the hallway between room #2 and room #3. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. Common Areas: Office space/ staff room is beside the entrance of the facility. The common room includes the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits enough for six (6). Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry area and detergents are located by the laundry room and is kept secured. The facility does not have a swimming pool or body of water. The garage is detached and is used for storage for incontinence for residents. Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Medications: Medication and Medication Records (MMR) were review for proper documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit interview conducted and a copy of the report issued.the state’s words, verbatim · CDSS document, Dec 12, 2023