<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850339
Report Date: 01/11/2024
Date Signed: 01/11/2024 02:56:18 PM

Substantiated


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
08/31/2023 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20230831162522
FACILITY NAME:INN AT THE PARK VENTURAFACILITY NUMBER:
195850339
ADMINISTRATOR:ANGUIANO, ROSEFACILITY TYPE:
740
ADDRESS:21200 VENTURA BLVDTELEPHONE:
(818) 884-7100
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91364
CAPACITY:200CENSUS: 158DATE:
01/11/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Rose AnguianoTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee does not ensure facility is free from bed bugs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent complaint visit to investigate the allegations listed above. Upon arrival LPA met with Administrator Rose Anguinao and explained the reason for the visit.

During the investigation, LPA's Martha Arroyo and Brian Balisi initiated the 10 day initial visit on 09/07/2023 between 9:30 a.m. - 4 p.m. LPA's toured the physical plant, interviewed fourteen (14) residents, three (3) staff and reviewed and obtained copies of pertinent documents relevant to the investigation. Today LPA conducted physical plant and reviewed and obtained additional documentation.

It was reported that the “Licensee does not ensure facility is free from bed bugs ”, as it was alleged that the facility has an ongoing issue of bed bugs. Interviews conducted with fourteen (14) residents revealed that eight (8) out of fourteen (14) residents interviewed have either observed bed bugs in their room or have heard of other residents observing bed bugs in their rooms.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 29-AS-20230831162522
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: 01/11/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from 9099

The other six (6) residents interviewed revealed they have not observed any bed bugs in their room or heard of other residents having a bed bug infestation. For any bed bug issues facility staff/management is alerted and pest control is scheduled to have each identified room/area with bed bug issue serviced accordingly and immediately. LPA’s records review of Hydrogen Pest Control invoices reflected that from 06/19/2023 to 08/29/2023 the pest control company conducted nine (9) appointments where evidence of bedbugs were observed during their visit. Based on information gathered over the course of the investigation, the Department has sufficient evidence to determine this allegation occurred. Therefore, the allegation that “Licensee does not ensure facility is free from bed bugs” has been deemed Substantiated at this time.

Pursuant to the California Code of Regulations, Title 22, Division 6, Chapter 6, the following deficiencies were observed and cited (9099-D) during the visit.

Exit Interview Conducted / Appeal Rights discussed and a copy of this report has been issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20230831162522
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/19/2024
Section Cited
CCR
87303(a)
1
2
3
4
5
6
7
87303(a) Maintenance and Operation - The facility shall be clean, safe, sanitary and in good repair at all times...safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by
1
2
3
4
5
6
7
The Administrator agreed to review section cited and provide a statement of understanding to LPA via email by 01/19/2024 COB. In addition Admin agreed to speak with pest control company regarding options for possible additional
8
9
10
11
12
13
14
Based on interviews and records review, the licensee failed to comply with the section cited above as bed bugs were observed by multiple residents in multiple bedrooms, which poses a potential health and personal rights risk to persons in care.
8
9
10
11
12
13
14
 preventative measures to limit bed bug infestations.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3