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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850339
Report Date: 04/05/2024
Date Signed: 04/05/2024 02:37:44 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
02/13/2024 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20240213163305
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:
04/05/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Rose AnguianoTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Resident was financially abused while in care
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 02/15/2024, from 01:50pm – 03:30 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 03/01/2024, LPA interviewed Resident #1 (R1) during a subsequent visit on a separate investigation.

It was reported that R1 was financially abused while in care , as it was alleged that someone at the facility used R1’s credit card without authorization. Interviews conducted and records reviewed revealed that from 01/23/2024 to 02/08/2024 multiple orders were purchased on Doordash with use of R1’s credit card.
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)
Page: 1 of 2
Control Number 29-AS-20240213163305
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

LPA’s interview with R1 stated they informed Staff #1 (S1) to make orders on Doordash and authorized S1 to use their credit card. R1 continued to state they only made purchases for themselves and not for any staff. LPA’s interview with S1 stated R1 does not have a phone and R1 would typically write down what they wanted to order on an index card and provide it to S1 to order through Doordash. S1 does not keep R1's credit card info on their phone and they do not order through Doordash for any other resident in care. LPA records review of R1’s Physicians’ Report indicated that R1 is able to manage own cash resources. LPA’s interview with four (4) residents who often get food delivered, revealed that all (4) residents have never had staff purchase anything for them with their own credit card. Each resident also have not witnessed any staff use any residents credit card to make purchases. 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 “R1 was financially abused while in care", 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)
Page: 2 of 2