195850339-8-15-2023-29-AS-DPEA-CUYTJ8-20230823144556

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850339
Report Date: 08/15/2023
Date Signed: 08/15/2023 01:12:09 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/07/2023 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20230807131405

FACILITY NAME:	INN AT THE PARK VENTURA		FACILITY NUMBER:	195850339
ADMINISTRATOR:	ANGUIANO, ROSE		FACILITY TYPE:	740
ADDRESS:	21200 VENTURA BLVD		TELEPHONE:	(818) 884-7100
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91364
CAPACITY:	200	CENSUS: 161	DATE:	08/15/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Rose Anguiano		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Wrongful eviction.
Staff did not prevent resident from wandering from the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Martha Arroyo conducted an initial complaint visit for the above allegations at 9:00 a.m. Upon arrival, the LPA was greeted by the front desk clerk. The Administrator arrived shortly after and the reason for the visit was explained. Entrance interview conducted.

During today's visit, the LPA conducted an interview with the Administrator at 9:55 a.m., conducted a resident file review at 10:30 a.m., and obtained copies of pertinent documents relevant to the investigation.

It was alleged that Resident #1 (R1) was wrongfully evicted. It was reported that R1 was not allowed back into the facility after being reported lost and brought back to the facility.

(Report Continued on LIC 9099C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230807131405

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: INN AT THE PARK VENTURA	FACILITY NUMBER: 195850339
	VISIT DATE: 08/15/2023

NARRATIVE

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(Report Continued from LIC 9099...)

Record review revealed R1 has not been evicted from the facility, nor have they been issued an eviction notice from the facility. Interviews conducted with the Administrator revealed R1 was never evicted from the facility; however, R1 was denied entry back into the facility when brought back to the facility the next day. Interview conducted with the Administrator revealed R1 was not looking too well and requested R1 to be taken to get medically assessed and cleared before being re-admitted to the facility. Later that day, R1 was assessed while outside of the facility and brought back. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “wrongful eviction”. Therefore, this allegation is being Unsubstantiated at this time.

It was also alleged that staff did not prevent resident from wandering from the facility. Record review of R1’s Physician’s Report dated; 02/27/2023 revealed R1 is ambulatory and able to leave the facility unassisted. The Administrator stated R1 is self responsible and tends to go out of the facility often. Additionally, the Administrator added that any resident that is able to leave the facility unassisted is able to do so at their discretion as long as they sign out by the front desk. This allows facility staff to know which residents’ have stepped out incase of an emergency. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “staff did not prevent resident from wandering from the facility”. Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC9099 (FAS) - (06/04)

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