Savant of Burbank West

Type of visit: Required - 1 Year

On 02/24/2026, at 9:00 am Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced required annual inspection. LPA met with Executive Director - Silvia Valdez and explained the reason for the visit. Facility is licensed as a two-story building. Fire clearance approved for one hundred (100) non-ambulatory residents; ten (10) of whom may be bedridden. Hospice waiver is approved for thirty (30) residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools. From 11:10am to 1:20pm, LPA along with the Executive Director, conducted a tour of the physical plant and observed the following: The Screening/Reception area is located immediately upon entrance. Required postings were displayed at the reception area. Facility’s main door is the primary entry/exit access. The facility has five (5) delayed egress exit doors. Facility has one elevator. LPA observed an evacuation chair atop of one (1) of the three (3) stairwells. COMMON AREAS: Facility is a two-story building; there are four common area bathrooms, in both floors. The first floor has two lobbies, a television room, dining room, hair salon and outside and an inside patio areas. In the hair salon, LPA observed a foldable weight station, used to weight residents and lockers for staff use. Second floor has an activity room. Common area floors and hallways were clean and without obstructions, all furnishings were observed to be clean and in good condition. Multiple dual smoke/carbon monoxide detectors are installed, hardwired, and interconnected throughout the facility. Multiple fire extinguishers were observed throughout both floors and all the fire extinguishers were last inspected on 05/08/2025 by Delta Fire Company, which is privately owned. Delta Fire Company conducts quarterly smoke/carbon monoxide detector and fire alarm testing, the last test was conducted on December 2025 Continued on 809-C The facility has cameras in common areas of the home. In addition facility offers telephone access and wi-fi access to residents in care. There are three stairwells and one elevator in the building; evacuation chairs were observed atop each stairwell. Roof is inaccessible to residents. Evacuation routes are clearly labelled and posted throughout the facility. SURROUNDING GROUNDS: The passageways and entrance to the home was clear of obstruction. Facility has an outdoor patio and an indoor patio area. LPA observed two sets of patio furniture with two umbrellas, in each patio. There are no bodies of water in the facility. KITCHEN: Facility has a commercial kitchen which is kept locked and inaccessible to residents. LPA observed an adequate supply of perishable foods for two (2) days, and non-perishable food supply for seven (7) days, which were stored in the refrigerator, freezer, and pantry. Food was properly labeled and stored. Emergency food is stored in a separate walk-in pantry. Sharps are stored in the kitchen; inaccessible to residents. LPA observed records of special dietary needs and weekly menu in the kitchen. BEDROOMS: LPA toured multiple resident bedrooms on both floors. All bedrooms were inspected and observed to maintain required furnishings and sufficient lightings, bed linens, and comforters. At 12:19pm in room# 224, LPA pulled the assistance cord; caregiver responded within 2 minutes; at 12:39pm in room# 112 LPA pulled the assistance cord; 2 caregivers responded within 2 minutes. BATHROOMS: All bathrooms were observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, non-slip mats). Hot water temperature measured between 108.5° F. and 113.2° F; within the required range. At 12:14pm in bathroom# 226, LPA pulled the assistance cord; caregiver responded within 1 minute. LAUNDRY ROOMS: There are two laundry rooms, one on each floor, with two washers and two dryers in each room. Chemicals and detergents were stored in a locked room near the laundry room, inaccessible to residents. STAFF RECORDS: All records are kept online, yet there are also files, stored and locked in the Business Office. A total of eleven (11) staff files were reviewed. Training, criminal record clearances were present, and staff are associated to this facility. Staff records appear to be complete and current. Continued on 809-C MEDICATIONS: Facility has a Wellness Room behind the front desk, in which all medications are securely locked, inaccessible to residents. LPA observed new medications being accounted for and being logged to the system. LPA reviewed Medication Administration Records (MARs) for nine (9) residents and compared them to the medication count and found no discrepancies. Multiple First Aid kits and the First Aid Manual were observed in the Wellness Room. RESIDENT RECORDS: A total of ten (10) resident files were reviewed for the following reports but not limited to: Appraisals, physician's reports, and admission agreements. Resident records appeared to be complete and current. In addition to the plant tour, LPA reviewed the facility's liability insurance, infection control plan, and disaster plan. Records were complete and up-to-date. Facility conducts quarterly Fire Disaster/Elopement and Emergency drills, the last drill was conducted on 01/03/2026. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit Interview Conducted / A Copy of the Report provided to Administrator.the state’s words, verbatim · CDSS document, Feb 24, 2026

Allegation investigated: Staff did not prevent residents from engaging in inappropriate interactions.

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 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 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. 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.the state’s words, verbatim · CDSS document, Oct 15, 2025 · control 31-AS-20250103082700

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Oct 22, 2025

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: 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.the state’s words, verbatim · CDSS document, Oct 15, 2025

Plan of correction: Staff will receive retraining on supervision and intervention procedures. The facility will ensure staff are assigned to monitor all common areas during resident use.

Type of visit: Case Management - Deficiencies

At 10:15 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted unannounced visit to this facility in conjunction with a complaint control #31-AS-20250103082700. LPA met with the Wellness Director Nancy Ruiz and later the Executive Director (ED) arrived at the facility. LPA explained the reason for the visit. During the visit, LPAs was informed that R1 was refusing to take his/her medication and other care services on multiple occasions. The facility staff did inform R1's Physician and family; however, no incident report was submitted to the Community Care Licensing Department (CCLD) in a timely manner. LPA reviewed all incident reports on a system and did not observe an Incident Report regarding R1. In addition, the ED and Wellness Director admitted that no incident was submitted to the Regional Office (RO). Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence. LPA informed ED that all staff members are mandated reporters and they are all responsible for reporting. LPA informed ED to submit an incident report for all the medication or other care services refusal that occurred during R1's stay at the facility. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D. Exit interview conducted, appeal rights and copy of report signed and delivered.the state’s words, verbatim · CDSS document, Oct 15, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)A,B&D · Plan of correction due date: Oct 22, 2025

Requirements (a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency and to the person... ... any of the events specified in (A), (B) & (D)... This requirement is not met as evidenced by: Based on interviews and record reviews, conducted by LPA, the licensee did not comply with the section cited above by failing to notify CCLD regarding R1's medication & services refusal on multiple occasions which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 15, 2025

Plan of correction: Executive Director shall ensure a written report is submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence of any of the events. R1's medication & services refusal incident report shall be submitted to LPA by POC date.

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPAs) Nadia Shahbazian and Evelin Rios conducted an unannounced site visit continuation of the required annual inspection conducted on 04/08/2025. LPAs met with Executive Director, Silvia Valdez and explained the reason for the visit. The following remaining inspection domains were observed, reviewed and inspected: Bedrooms: LPAs toured multiple resident bedrooms on both floors for health and safety, (Bedrooms # 104, 112, 114, 209, 233). The bedrooms were inspected and observed to maintain required furnishings and sufficient lightings, bed linens, and comforters. All bedrooms were observed to be clean and clear of obstructions. At 12:39 pm in room# 112, LPAs pulled the assistance cord; caregiver responded within 2 minutes. Bathrooms were observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, non-slip mats). Hot water temperature measured between 107.4° F. and 111.6° F; within the required range. At 1:11pm in bathroom# 233, LPAs pulled the assistance cord; caregiver responded within 3 minutes. Continued on 809-C Laundry Rooms: There are two laundry rooms, one on each floor, with two washers and two dryers in each room. Chemicals and detergents were stored in a locked room near the laundry room, inaccessible to residents. Resident records: All records were observed as locked and inaccessible to residents. A total of six (6) resident files were reviewed for the following reports but not limited to: Appraisals, physician's reports, and admission agreements. Resident records appeared to be complete and current. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit Interview Conducted / A Copy of the Report provided to Administrator.the state’s words, verbatim · CDSS document, Apr 9, 2025

Type of visit: Required - 1 Year

On 04/08/25, 9:00 am Licensing Program Analysts (LPAs) Nadia Shahbazian and Evelin Rios conducted an unannounced required annual inspection. LPAs met with Executive Director, Silvia Valdez and explained the reason for the visit. Facility is licensed as a two-story building. Fire clearance approved for one hundred (100) non-ambulatory residents; ten (10) of whom may be bedridden. Hospice waiver is approved for thirty (30) residents. LPAs requested copies of the resident roster, Personnel Report (LIC 500), nine (9) randomly selected resident records and seven (7) staff files. At approximately 10:00 am, LPAs reviewed seven (7) randomly selected staff files for completeness, LPAs observed the files to be complete with updated training records. From 12:00 pm to 1:20 pm, LPAs along with the Executive Director conducted a tour of the physical plant. During the tour, LPAs interviewed six (6) residents and four (4) staff. During the physical plant tour LPAs observed the following: The Screening/Reception area is located immediately upon entrance. Required postings were displayed at the reception area. Facility’s main door is the primary entry/exit access. The facility has five (5) delayed egress exit doors. LPA tested one of the delayed egress doors on the first floor and observed it to function properly. Facility has one elevator. LPAs observed an evacuation chair atop of one (1) of the three (3) stairwells. Common areas: First floor has a dining room, lobby/television room, outside and an inside patio areas. Second floor has an activity room. Common areas observed to be clean and furnishings observed to be in good condition. No obstructions or hazards were observed. Carbon monoxide detectors were observed on the first floor and were functional. Fire extinguishers are located all throughout the facility and last inspected on 04/01/2025. The facility is equipped with cameras in common areas and a sprinkler system. Kitchen: Facility’s kitchen was observed to be clean, sanitary, and inaccessible to residents. LPAs observed an adequate supply of perishable foods for two (2) days, and non-perishable food supply for seven (7) days, which were located in the refrigerator, freezer, and pantry. Food was properly labeled and stored. Emergency food is stored in a separate walk-in pantry. Sharps are stored in the kitchen; inaccessible to residents. LPAs observed records of special dietary needs and weekly menu in the kitchen. Medications were kept in locked medication carts in the medication room, inaccessible to residents. LPA observed complete first aid kits and first aid manual in the medication room. At 1:25 p.m., medications and medication records for ten (10) residents were reviewed by LPA Shahbazian with the assistance of the Regional Director, Lisa Pham. Facility Disaster drill was last conducted on 03/25/2025. Fire protection equipment were last inspected by Delta Fire Equipment, INC on 05/13/2024. Review of records indicate facility passed the annual fire inspection. LPA Rios reviewed the facility's liability insurance, infection control plan, and disaster plan. Records were complete and up-to-date. Due to time constraints, LPAs were unable to complete today's annual inspection. LPAs will complete the inspection at a later date. Exit interview conducted. Copy of report provided to Executive Director.the state’s words, verbatim · CDSS document, Apr 8, 2025

Type of visit: Case Management - Health Checks

At 1:15 p.m. on 03/04/25, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced case management visit. LPA met with the administrator and disclosed the reason for the visit. Today’s case management visit was conducted to ensure the three (03) residents relocated from Rossmoyne Hills (197610495) were afforded their health and safety at their current home. LPA toured the facility at 1:15 p.m. today, interviewed Resident #2 (R2) at 1:30 p.m., Resident #4 (R4) at 1:35 p.m., and the administrator at 1:45 p.m. Interview with the administrator revealed Resident #6 (R6) stayed temporarily at the facility for a day. After an assessment, R6 was determined to have needs which were beyond the capacity of the facility and was replaced to a skilled nursing facility. Interviews with R2 and R4 revealed they enjoy their current facility, and all of their needs are taken care of by staff. LPA concluded the visit and provided contact information to both residents in care. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Mar 4, 2025

Allegation investigated: Illegal Eviction

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 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.the state’s words, verbatim · CDSS document, Dec 18, 2024 · control 31-AS-20241211152351

Allegation investigated: Resident sustained multiple injuries while in care Staff did not safeguard resident's personal belongings Staff did not ensure resident was in clean clothing Facility is malodorous

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 Unsubstantiated Orders, Preplacement Appraisal, Individual Service Plan, Hospice file, Unusual Incident Reports & laundry schedule. Prior to this visit on 12/10/2024 LPA Antonia Alvizar-Ettima reviewed the information and the documents previously obtained from the facility. At the time of this visit at approximately 11:10a.m., LPA Alvizar-Ettima and Wellness Director conducted a physical plan tour. 1.) Resident sustained multiple injuries while in care. It was alleged that facility resident #1 (R1) sustained multiple injuries resulted from falls. During interviews ED and other staff verified that R1 had a fall. However, they denied being neglectful in R1’s care. R1 was receiving hospice services. On 05/14/2024, they did have an unwitnessed fall and was sent to the hospital. After resident came back, their in-house care plan was updated to address fall prevention. Hospice visits were increased and additional three (03) extra hours were added for one-on-one supervision. Bed rails were ordered by hospice agency to prevent R1 from falling. Other residents interviewed had no issues or concern regarding their care and supervision provided in the facility. During this visit R1 was present at the facility. At (time) LPA attempted to interview R1, but no able. A review of the facility records verified the information revealed by the staff. There was no information on evidence available during this investigation to conclude that R1 sustained multiple fall injuries due to staff neglect. Therefore, based on observation, interviews and record review, the allegation is UNSUBSTANTIATED at this time. 2.) Staff did not safeguard resident's personal belongings. It was alleged that all R1’ clothing gone missing, and staff do not log any items in resident’s file. Staff revealed that when R1’s family members drop off clothes at the front office. Front office staff write R1’s name on it and document the personal belonging (clothing) in an inventory log. Interviews with eight (08) out of eighty-nine (89) residents confirmed the information that staff provided. Resident’s interviews revealed that they never had their items go missing and have no concerns regarding facility staff not safeguarding personal items. A review of facility Resident Personal Property and Valuables, Inventory of Personal Effects, Resident’s Clothing and Possessions documents indicate that staff logged R1 clothing. No supporting information was available during this investigation to verify the allegation. Therefore, based on interviews and record review, the allegation is UNSUBSTANTIATED at this time. Continue on LIC 9099 -C 3.) Staff did not ensure resident was in clean clothing. It was alleged that R1’s clothing always has a strong smell of urine. During resident’s interviews, LPA observed residents to be clean, well-groomed, and not smelling like urine. Staff revealed that all resident’s clothes is washed based on their laundry schedule date. S2 indicated that R1’s clothes are schedule to be washed three time a week or more if needed. Other residents’ interviews revealed that staff always clan them up and wash their clothing. Resident denied having urine smell on their clothes. A review of facility laundry schedule confirmed the information provided by staff. No supporting information was available during this investigation to verify the allegation. Therefore, based on interviews and record review, the allegation is UNSUBSTANTIATED at this time. 4.) Facility is malodorous. It was alleged that the facility has a strong smell of urine. During physical plant tour, LPA was not exposed to offensive odor of urine in the hallways, common areas, nor in resident’s room. Staff (S1) recalled providing daily services in R1’s room and did not observe any malodorous odor. Staff revealed that house cleaning is performed seven (07) days of the week and daily tidy of the rooms which includes removal of any unpleasant offensive odor. Resident’s interviews revealed that they have not been exposed to urine odor in their room or common areas. staff always clans their rooms and remove wet diapers pr dirty clothing and never have urine smell. No supporting information was available during this investigation to verify the allegation. Therefore, based on interviews and observation, 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, Dec 11, 2024 · control 31-AS-20240530130158

Allegation investigated: Staff are not providing resident with oxygen resulting in hospitalization.

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) Unsubstantiated During interviews with staff, Staff #1 (S1) and Staff #2 (S2) stated all residents using oxygen in the facility are receiving hospice services and all oxygen administration in the facility is performed by their respective hospice agency nurses. Staff added if they see a change in condition, they immediately contact the hospice agency, and an appropriately skilled professional is dispatched. Based on record review and interview, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No health and safety hazards noted during the visit. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 20, 2024 · control 31-AS-20241118083437

Allegation investigated: Staff handle resident in a rough manner Staff are not addressing the residents dental needs

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. Unfoundedthe state’s words, verbatim · CDSS document, Nov 6, 2024 · control 31-AS-20241030100418

Allegation investigated: Staff did not notify resident's responsible party of a change in condition Staff did not administer resident's medications as prescribed Staff did not assist resident with feeding Staff did not ensure resident's hygiene needs were being met

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 Unsubstantiated reports and other documents obtained from the facility. During this visit at 1:45PM De Luna and LPA conducted a physical plan tour. Between 2:00PM – 3:30PM LPA conducted interviews with facility staff and nine (09) out of ninety-three (93) residents. LPA asked questions relevant to the nature of the complaint. At the time of investigation, R1 was no longer at the facility. 1.) Staff did not notify resident's responsible party of a change in condition. It was alleged that R1’s health declined, and staff never told R1’s responsible party about changes in R1’s overall health condition. Interview of facility staff revealed that staff always monitor resident's health conditions and notify resident’s responsible party if changes were noted. A review of incident report reveal that on July 31, 2023, while R1 was at an overnight stay with family, it was noted that R1 had a change of mental and physical condition. Residents interview indicated that staff always call their responsible party when they are sick and go to the hospital. Based on interviews and records review there is not sufficient information to support this allegation. Thus, this allegation is deemed to be UNSUBSTANTIATED at this time. 2.) Staff did not administer resident's medications as prescribed It was alleged that Resident #1(R1) was not given medication as prescribed by physician. Staff interviews reveal that medications are always dispensed to residents as per physician order and prescription. Staff indicated that R1 sometimes refused to take medications. A review of incident reports involving R1, revealed that that at times R1 was getting agitated and refused to eat, drink, and take medication. The report verified the information received from facility staff. A review of R1’s Medication Administration Record supported the information received from staff. Residents interview revealed that staff do administer medications as prescribed and on time. Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. Continue on LIC 9099c 3.) Staff did not assist resident with feeding It was alleged that R1 needed feeding assistance and staff did not provide it. Staff interviews reveal that R1 did not need feeding assistance. Staff indicated that R1 was able to self-feed. A review of R1’s Physician Report, capacity for self-care record verified the information received from facility staff. Residents indicated that staff do assist and supervise resident during meal times. Based on interviews and record review, there is insufficient information to verify the allegation. Therefore, the allegation is unsubstantiated at this time. 4.) Staff did not ensure resident's hygiene needs were being met It was alleged that R1 needed toileting & bathing assistance and staff did not provide it. Staff interviews reveal that R1 was capable of self-care and did not need hygiene assistance. However, R1 needed bathing supervision but was refusing the assistance. Physician Report, capacity for self-care record verified the information from facility staff. Facility documents indicated that R1 was receiving bathing assistance on a weekly basis. However, sometimes R1 would refuse staff assistance. Residents interview revealed that staff are always assisting residents and have not seen residents with hygiene needs not being met. Based on the interviews, information obtains and record review, this allegation is deemed unsubstantiated at this time. No immediate health and safety issues were noted. Exit interview was conducted and copy of was provided.the state’s words, verbatim · CDSS document, Oct 23, 2024 · control 31-AS-20230901160257

Type of visit: Required - 1 Year

Licensing Program Analyst (LPAs) Antonia Alvizar and Gary Tan conducted an unannounced Required One (1) year at this facility today. LPAs met with Executive Director, Silvia Valdez, Regional Director, Nirjara Acharya and explained the reason for the visit. A tour of the physical plant was conducted at 10:00 AM and the following was noted: The facility consists of a two-story structure that contains the following: Entrance / Lobby 1, an office for staff, and Lobby 2 / TV room areas for residents’ use, an interior courtyard, a dining room, a kitchen, a laundry room on first and second floors, storage space on first and second floors. There is only one entrance being utilized at the facility, all required posters were posted at the entrance. The screening area is in the lobby. Sign in sheet, hand sanitizer, gloves and masks are available. Some staff were observed to be wearing masks during this visit. Hand washing, coughing etiquette, physical distancing, and other necessary signs were posted in the bathroom and all over the facility. The facility has a total of fifth-three (53) shared bedrooms. The facility is fire cleared for one hundred (100) non-ambulatory residents, ten (10) of which maybe bedridden. Approved hospice waiver for thirty (30) residents. Special Conditions on the fire clearance state the following' "Approved sliding door and window security locks for second floor dementia patient rooms". Dementia Care is listed in the plan of operation and facility accepts residents with dementia. Common areas were inspected. The activity room is located on the second floor. Dining area was observed to be neat, clean and in proper order. The facility maintains a comfortable temperature at 74°F. There are carbon monoxide detector installed in the facility. Fire extinguishers are located all throughout the facility and last inspected on 03/31/23. The facility is equipped with emergency pull alarm and sprinkler system. Laundry room on the first and second floors and was observed to be locked. Laundry detergents, cleaning agents and other toxins are stored space in the second-floor locked storage room #225 inaccessible to the residents. Food Service/Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food. Knives and sharp objects were observed to be locked and inaccessible to residents. The residents' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lit. The bathroom was checked for cleanliness and proper operation. LPA observed that there are appropriate grab bars in the showers and toilets. The hot water temperature measure was at a range of 105.9°F to 111.3°F. There was enough clean linen available in the closets. Medications were kept in locked medication carts in the medication room. The medications were observed to be locked and inaccessible to residents. There are multiple complete first aid kits located in the medication room. Facility emergency disaster plan was reviewed. Facility disaster drill was last conducted on 02/27/2024. A fire inspection by the LAFD was last performed on 05/05/2023. In addition to the physical plant inspection, residents and staff records were reviewed. There is no body of water at the facility. Back and front yard passageways were observed to be clear from obstruction. There is a shaded area in front of the building for residents. LPAs reviewed files of six (6) randomly selected residents. Residents’ files appear to be complete and updated. Six (6) staff files were also reviewed, staff files appear to be complete and updated. Exit interview conducted. A copy of this report issued.the state’s words, verbatim · CDSS document, Mar 9, 2024

Allegation investigated: Staff did not provide timely medical attention, which may have controbuted to death Staff were unaware of resident’s POLST

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) witnesses assisting R1. Between 2:00p.m.-2:30p.m. LPA interviewed facility staff #1 (S1). LPA asked questions relevant to the nature of the complaint. Unsubstantiated 1.Staff did not provide timely medical attention, which may have contributed to death. It was alleged that facility staff did not contact 911 within reasonable time. Interview of facility staff revealed that they had no knowledge that R1 needed medical attention due to Hospice nurse being present at R1’s bedside. S1 revealed that they had no knowledge that R1 required emergency medical attention. 911 was contacted by the hospice personnel that were present in R1’s room. Witness #2 (W2) indicated that witness #1 (W1) was present when R1 was taking they last breath. W1 indicated that they were present at the facility when R1 stopped breathing. W1 verified being in the room with R1 and did not notify facility staff that R1 needed medical attention. W1 indicated that R1 became unresponsive around 4:20p.m. W1 immediately contacted the hospice agency, then contacted 911 and conducted Cardiopulmonary Resuscitation (CPR) while they were waiting for Paramedics. W1’s response coincides with the information received from facility staff. A review of facility internal incident log/notes did not indicate any information to conclude that facility staff had knowledge that R1 needed medical attention. Overall investigation revealed that 911 call was made by W1 within less than 4 min. after resident became unresponsive. Based on interviews and documents review there is an insufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. 2.) Staff were unaware of resident’s POLST. It was alleged that facility did not honor R1’s Physician Order for Life-Sustaining Treatment (POLST) and no Cardiopulmonary Resuscitation (CPR) was provided to R1 after they became unresponsive. Staff revealed that Hospice nurse was present at the R1’s bedside when R1 was transitioning and became unresponsive. Hospice agency had a copy of R1’s Emergency Contact information as well as copy of POLST. Hospice personnel did not inform the facility staff that R1 required medical attention and became unresponsive. Therefore, they were unable to discuss R1’s POLST with the hospice personnel. Witnesses’ interviews reveal that W1 was aware of R1’s POLST and attempted CPR on R1. Record review indicated that R1 has a POLST in facility file. Based on interviews and documents review there is an insufficient information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No immediate health and safety hazard is noted during this visit. Exit interview conducted with WC and a copy of this report was issued.the state’s words, verbatim · CDSS document, Mar 8, 2024 · control 31-AS-20240228160422