195850339-4-5-2024-29-AS-DPEA-D4TLQQ-20240430085755

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850339
Report Date: 04/05/2024
Date Signed: 04/05/2024 02:34:22 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
10/09/2023 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20231009145534

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: 168	DATE:	04/05/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Rose Anguiano		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff stealing resident’s personal belongings.
Staff not providing resident with adequate food service.
Staff opens resident’s packages.
Staff disrupting resident’s sleep.
Staff allowing resident’s to smoke in non-designated smoking areas of facility.

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

On 10/10/2023, from 02:30 p.m. – 4:20 p.m., LPA 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. On 01/11/2024, LPA interviewed twelve (12) residents while conducting a subsequent visit on a separate investigation.

It was reported that “Staff stealing resident’s personal belongings”, as it was alleged that staff were taking Resident #1 (R1)’s hair wraps, earrings, DVD player and pillow cases. Interviews conducted and records review revealed that R1 declined to have their personal items inventoried.
Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

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-20231009145534

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: 04/05/2024

NARRATIVE

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Continued from 9099
Interview with sixteen (16) residents revealed that all (16) residents have never observed staff take any of their personal belongings. Each resident did not express any immediate or potential concerns for any staff taking their personal belongings. LPA’s interview with five (5) staff revealed that all (5) have never observed any staff take the personal belongings of any resident. Each staff interviewed did not express any immediate or potential concerns for any staff taking the personal belongings of residents in care. Records review revealed R1 declined to have personal items inventoried.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 stealing resident’s personal belongings” is deemed Unsubstantiated at this time.

It was reported that “Staff not providing resident with adequate food service”, as it was alleged that food is not cooked properly and fruits are not ripe. Interviews conducted with sixteen (16) residents revealed that fourteen (14) out of (16) residents interviewed stated that they have not observed any food that appeared to not have been cooked to the proper temperature. These residents continued to state they are frequently provided with a variety of fruits and vegetables, and they have not observed any produce that was not safe to eat. Two (2) out of the (16) residents interviewed stated that the food was observed to be cooked properly, but the food could use more flavoring such as additional salt, pepper or other seasonings. LPA records review of Nutritionist report dated 10/14/2023, notated that the overall kitchen maintenance and cleanliness met compliance and the facilities 5-week cycle menu was reviewed and no suggestions were provided. During physical plant in the kitchen, LPA observed a sufficient number of fruits, produce, breads, pasta, and non-perishable items properly stored. 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 not providing resident with adequate food service” is deemed Unsubstantiated at this time.

It was reported that “ Staff opens resident’s packages, as it was alleged that whenever residents receive packages it comes to them already opened. Interviews conducted with sixteen (16) residents revealed that twelve (12) residents have never received a package that had been opened prior to them receiving it from staff.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20231009145534

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: 04/05/2024

NARRATIVE

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Continued from 9099-C
Two (2) out of the (12) residents interviewed stated they don’t receive packages in the facility while the other (2) residents stated they have received packages that appeared to be opened and repackaged, but they feel it may have been more likely due to being damaged from the courier service. LPA’s interview with four (4) staff revealed that typically packages get received by the front desk, then staff inform the resident of the package, and they either retrieve it from the front desk or staff deliver it directly to them. Each staff continued to state there would be no protocol in which, staff have to open the residents’ package before handing it over to the resident. 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 opens resident’s packages” is deemed Unsubstantiated at this time.

It was reported that staff are disrupting resident’s sleep, as it was alleged that staff are entering R1’s room while they are sleeping at night. Interviews conducted with sixteen (16) residents revealed that all (16) residents have not been woken up by staff during the night. Each resident continued to state they are okay with wellness checks during the night to ensure the health and safety of the residents. LPA’s interview with four (4) staff revealed that when a resident has a change of condition or suffers a fall / injury, staff conduct wellness checks on resident throughout the day and during the NOC shift. NOC shift staff are instructed to open the door slightly and take a peek inside room to ensure the health and safety of the residents. Residents are allowed to opt out of having wellness checks conducted as well. 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 are disrupting resident’s sleep “is deemed Unsubstantiated at this time.

It was reported that staff are allowing residents to smoke in non-designated smoking areas of facility, as it was alleged that some residents are smoking in their rooms. LPA’s interview conducted with sixteen (16) residents revealed that thirteen (13) out of the (16) residents interviewed have not observed any resident smoking in their room. These residents also did not express any immediate or potential concerns of residents smoking in their room and that they typically observe the same group of residents smoking smoking in the rear of the facility in the designated smoking area. Three (3) out of the (16) residents interviewed stated residents smoking in their rooms used to be an issue in previous years,

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20231009145534

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: 04/05/2024

NARRATIVE

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Continued from 9099-C

but they have not smelled any evidence of smoke in their unit or common areas lately. During physical plant, LPA did not observe any evidence of residents smoking in the resident’s room and LPA also observed a large group of residents smoking in the designated smoking area. 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 are allowing residents to smoke in non-designated smoking areas of facility”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: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

LIC9099 (FAS) - (06/04)

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