BURBANK MANOR

Official classification

Type B

Official code

87205(a)

Regulation authority

CCR

What the official deficiency says

87205 Accountability of Licensee Governing Body (a)The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and... with these regulations and the welfare of the individuals it serves. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in the licensee was paying the majority of bills late, including facility rent which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee to submit to Community Care Licensing audit documents on two (2) dates. Documents are to include bank statements for all bank accounts the facility uses for their operation, all pages, electricity bills, gas bills, cable bills, garbage bills, water bills, federal payroll tax payment records, California payroll tax payment records, and monthly operating statements LIC 401, LIC 401A and Balance Sheet LIC 403, LIC 403A.

Deadline recorded: Jan 15, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in that four (4) out of four (4) residents files (for residents R1, R2, R3 and R4) did not have an LIC 603 Preplacement Appraisal Information form which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/20/2025 Plan of Correction Licensee will submit completed and signed LIC 603 Preplacement Appraisal Information forms for residents R1, R2, R3 and R4 to Community Care Licensing by POC due date of 11/20/2025.

Official classification

Type B

Official code

87213

Regulation authority

CCR

What the official deficiency says

87213 Finances The licensee shall have a financial plan..., Application for License, and that assures sufficient resources...for care of residents;... and shall submit such financial reports as may be required upon the written request of the licensing agency. This requirement is not met as evidenced by: Based on observation & interviews, the licensee did not comply with the section cited above in that the facility's rent was not paid on time per the lease agreement for three (3) months which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee to submit an LIC 9098 Proof of Correction stating that the facility's rent will be paid on time per the lease agreement in the future. Licensee will also submit financial records requested by Community Care Licensing by the POC due date of 11/20/2025.

Deadline recorded: Nov 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal...This requirement is not met as evidenced by: Based on observation & interviews, the licensee did not comply with the section cited above in the shed at the back of the facility was being used for occupancy which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee to submit an LIC 9098 Proof of Correction stating that the shed in the back of the facility will only be used for storage and will not be used for sleeping or a break area to Community Care Licensing by the POC due date of 11/20/2025.

Deadline recorded: Nov 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Deficient Practice Statement Based on observatio, the licensee did not comply with the section cited above in 3 out of 3 disinfectants were available to clients in care (2 bathrooms Lysole) and cleaning supply cabinet unlocked in laundry room, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/29/2023 Plan of Correction Licensee to discuss regulation with staff, submit acknoledgement of understanding of regulation with signed & dated staff to CCL by 11/29/2023 to clear POC.

Official classification

Type A

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. This requirement has not been met as evidenced by: Deficient Practice Statement Based on observation, record review, and interview the Licensee/Administrator did not comply with this section above due to Licensee's Administrators Certificate expired 10/3/2021. Although another staff has current Administrator certificate, they are not the Administraor and have not been present full time since 10/3/2021.Licensee claimed all items were submitted for renewal of administrator certificate but after calling while LPA was at facility found out from Administrator certificate unit, certificate is not pending or active. This regulation poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/29/2023 Plan of Correction Licensee to obtain actual certificate and submit to CCL proof of submission. During time, Licensee to ensure interim certified Administrator is on site while Licensee is renewing certificate. Copy of Personnel Summary outlining administrator's hours to be submitted to CCL by POC due date of 12/5/2023. Licensee to submit Administraotr Certificate to CCL when obtained.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 4 out of 6 resident files did not have reappraisals conducted in the last 12 months which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/05/2023 Plan of Correction Plan of Correction (POC) shall include that ALL residents have Reappraisals performed in accordance with regulation. Furthermore, Licensee shall conduct staff training on reappraisals and a plan for future compliance. Submission of plan for future compliance and 4 reappraisals to be submitted to CCL by POC due date of 12/5/2023

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

87411(c )(1) Personnel Requirements – General All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview & record review, the licensee did not comply with the section cited above in 1 out of 4 staff records reviewed did not have current required First Aid Certificate on file, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/05/2023 Plan of Correction Licensee/Administrator to ensure all staff have required first aid certification training. Submit proof of staff's first aid certification by POC cleared at visit.