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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850339
Report Date: 03/01/2024
Date Signed: 03/01/2024 02:47:59 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
11/16/2023 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20231116084346
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: 168DATE:
03/01/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Rose AnguianoTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff do not respond to resident's call button in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit to deliver final findings of the allegation listed above. During today’s visit, LPA met with Administrator Rose Anguiano and explained the reason for the visit.

On 11/20/2023, from 10:30 a.m. – 12:30 p.m., LPA conducted an unannounced complaint investigation for the allegations listed above. During the visit, LPAs toured the physical plant, interviewed staff, and reviewed and obtained pertinent documents relevant to the investigation.

It was reported Staff do not respond to resident's call button in a timely manner, as it was alleged that residents have to wait for long periods of time before they receive assistance. Interviews with twelve (12) residents revealed that all twelve residents did not express any immediate or potential concerns with the timeliness of staff responding when assistance is requested.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
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 2
Control Number 29-AS-20231116084346
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: 03/01/2024
NARRATIVE
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Continued from 9099

Most residents stated that the most they've had to wait is approximately 10 - 12 minutes. LPA's interview with four (4) staff revealed when a resident requests service either by pulling their emergency cord in their unit or calling the front desk, their goal is to arrive to their unit within 5 to 10 minutes. LPA' records review of facilities response log, Tek-Care report , which logs response times when a resident pulls an emergency cord, the average response time for staff since Jan 01/04/2024 is 05 min and 52 seconds. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Staff do not respond to resident’s call button in a timely manner” is deemed Unsubstantiated at this time.

Exit interview conducted and copy of report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2