195850339-3-19-2024-29-AS-DPEA-D3T4JL-20240328190856

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850339
Report Date: 03/19/2024
Date Signed: 03/19/2024 02:57:10 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
08/29/2023 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20230829112438

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: 165	DATE:	03/19/2024
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Rose Anguiano - Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff threatened resident.

Staff spoke inappropriately to resident.

Staff hit resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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 Executive Director Rose Anguiano and explained the reason for the visit.

On 09/07/2023, from 09:30 a.m. – 4:00 p.m., LPA’s Martha Arroyo and Brian Balisi initiated an unannounced complaint investigation for the allegations listed above. During the visit, LPAs toured the physical plant, interviewed staff, residents and reviewed and obtained pertinent documents relevant to the investigation.

It was reported that staff threatened resident, as it was alleged that staff have threatened to relocate Residents. Interviews conducted with thirteen (13) residents revealed that twelve (12) out of the (13) residents interviewed have never witnessed any staff threaten to relocate any resident. One (1) resident declined to answer. LPA’s interview with five (5) staff revealed that each staff have not witnessed any staff threaten any resident in care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

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-20230829112438

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: 03/19/2024

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
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 threatened resident” is deemed Unsubstantiated at this time.

It was reported that staff spoke inappropriately to resident, as it was alleged that the Executive Director speaks inappropriately to residents. Interviews conducted with thirteen (13) residents revealed that eleven (11) out of (13) residents interviewed have never observed the Executive Director speak inappropriately to any residents. One (1) resident declined to answer and one (1) resident stated a staff was rude on one occasion , but they could not recall the name of staff or when the incident occurred. In addition, that resident stated it occurred when they were first admitted into the facility over one year ago and they have not experienced any staff speaking inappropriately to any resident since. LPA’s interview with five (5) staff revealed that each staff have not witnessed any staff threaten any resident in care. 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 spoke inappropriately to resident” is deemed Unsubstantiated at this time.

It was reported that Staff hit resident, as it was alleged a resident informed their family / responsible party they were hit by a staff. Exact dates or names of staff were not provided. Interviews conducted and records reviewed reflected that at the time of the complaint there were no incidents that occurred that involved a staff hitting a resident. LPA’s interview with thirteen (13) residents revealed that all (13) have not witnessed any staff hit a resident in care. LPA’s interview with five (5) staff revealed that each staff have not witnessed any staff hit a resident in care. 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 hit resident” 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: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2