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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 02:43:10 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
01/04/2024 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20240104092147
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):
1
2
3
4
5
6
7
8
9
Staff does not ensure facility is free of pests for residents in care

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 investigate the allegations listed above. During today’s visit, LPA met with Executive Director Rose Anguiano and explained the reason for the visit.
On 01/11/2024, from 10:30am – 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. Today LPA conducted physical plant, interviewed staff and reviewed and obtained copies of additional pertinent documentation relevant to the investigation.

It was reported that Staff does not ensure facility is free of pests for residents in care, as it was alleged that residents have observed bed bugs, mosquitos and other bug infestations in their room. LPA’s interview with twelve (12) residents revealed that seven (7) out of the (12) 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: 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 4
Control Number 29-AS-20240104092147
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

The other five (5) residents revealed they have not observed any bed bugs in their room or heard of other residents have a bed bug infestation. All (12) residents interviewed stated they have not observed mosquitos or other bug infestations in their room or around the facility. For any 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 since 01/25/2024 the pest control company has conducted seven (7) visits for ongoing treatments in select rooms and common areas. No bed bug activity has been observed, however on 03/11/2024 it was notated that a “minor roach infestation” was observed in kitchen and treated during the 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.

Although the allegation as Substantiated, the allegation was cited on a separate report from a separate complaint investigation Complaint Control #29-AS-20230831162522


Exit Interview Conducted and a copy of this report has been 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 4
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
01/04/2024 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20240104092147

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):
1
2
3
4
5
6
7
8
9
Staff does not ensure pest issue is being properly addressed for residents in care

Administrator does not treat resident with dignity and respect
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 investigate the allegations listed above. During today’s visit, LPA met with Executive Director Rose Anguiano and explained the reason for the visit.

On 01/11/2024, from 10:30am – 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. Today LPA conducted physical plant, interviewed staff and reviewed and obtained copies of additional pertinent documentation relevant to the investigation.

It was reported that “Staff does not ensure pest issue is being properly addressed for residents in care”, as it was alleged that the Administrator was informed of bug infestation but did not get it serviced in a timely manner.
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: 3 of 4
Control Number 29-AS-20240104092147
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
1
2
3
4
5
6
7
8
9
10
11
12
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14
15
16
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Continued from 9099-A

Interviews conducted and records review revealed the Administrator was informed of a mosquito infestation on 12/15/2023 in Resident #1 (R1)’s bedroom. Hydrogen Pest Control conducted a visit on 12/18/2023 and their inspection notes indicated that there were no evidence of bed bugs or general pest activity found at the time of their inspection. LPA’s interview with twelve (12) residents revealed that all (12) residents did not express any immediate or potential concerns of staff not addressing their concerns if a pest infestation were to arise. LPA’s records review of Hydrogen Pest Control invoices reflected that since 01/25/2024 the pest control company has conducted seven (7) visits for ongoing treatments in select rooms and common areas. 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 does not ensure pest issue is being properly addressed for residents in care” is deemed Unsubstantiated at this time.

It was reported that “Administrator does not treat resident with dignity and respect”, as it was alleged that resident’s concerns are ignored by the Administrator. LPA’s interview with twelve (12) residents revealed that ten (10) out of the (12) residents interviewed stated they speak with the Administrator often and they have not felt like their needs or concerns were ignored by the Administrator. Two (2) out of the ten (10) residents interviewed stated they don’t speak to the Administrator often enough to form an opinion, but each did not express any immediate or potential concerns that the Administrator would ignore their requests or concerns. 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 “Administrator does not treat resident with dignity and respect” 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: 4 of 4