195850339-7-30-2024-29-AS-DPEA-D7PSJF-20240731135504

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850339
Report Date: 07/30/2024
Date Signed: 07/30/2024 01:43:12 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
01/22/2024 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20240122102959

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: 176	DATE:	07/30/2024
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Rose Anguiano		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility staff mismanged residents medication

Staff member yells at resident(s) in care.

Staff do not ensure that facility is clean.

Staff do not ensure that fire exits are free of obstruction.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit to continue investigation for the above allegations. During today’s visit, LPA met with Rose Anguiano and explained the reason for the visit. During the visit Rose had to leave due to an appointment, but stated Tina can sign in their place.

On 01/24/2024, the initial complaint visit was conducted by LPA Brian Balisi between approximately 09:45 a.m. - 3:00 p.m. During the visit, LPA’s conducted physical plant, interviewed staff, residents, medication audit as well as, reviewed and obtained copies of pertinent documentation relevant to the investigation. On 07/23/2024, LPA interviewed residents while conducting a visit on a separate investigation.

It was reported that facility staff mismanaged resident’s medication, as it was alleged some residents are being over medicated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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-20240122102959

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: 07/30/2024

NARRATIVE

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continued from 9099

LPA's medication audit of Medication Administration Records (MAR) for eight (8) randomly selected residents indicated that medications for the residents were administered as prescribed at this time. LPA also checked resident medications for expiration dates and instructions and the LPA uncovered minimal discrepancies.The LPA reviewed facility incident reports, and the LPA was unable to uncover incident reports as it related to known medication errors. Interviews with five (5) staff revealed that staff did not recall specific occurrences where medication errors occurred. LPA's Interview with ten (10) residents in care revealed they did not express any concerns as it related to receiving their medications. 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 mismanaged resident’s medication” is deemed Unsubstantiated at this time.

It was reported that “Staff member yells at resident(s) in care”, as it was alleged that the Executive Director yells at residents and ignores their concerns. Interviews conducted with ten (10) residents revealed that nine (9) out of (10) residents interviewed have never observed the Executive Director to speak inappropriately to any resident or ignore their concerns . One (1) resident stated they have heard the Executive Director raise their voice attempting to redirect a resident who was yelling at the Executive Director. LPA’s interview with eight (8) staff revealed that each staff have not witnessed any staff yell at any resident or ignore any concerns of the residents 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 member yells at resident(s) in care” is deemed Unsubstantiated at this time.

It was reported that "Staff do not ensure that facility is clean" as it was alleged that the facility is roach infested, unkept and there is a bad smell throughout the hallways. Interviews conducted with ten (10) residents revealed that all (10) have not observed roaches in the facility , have never observed a foul order in the facility and have observed dedicated housekeeping staff cleaning throughout the day.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20240122102959

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: 07/30/2024

NARRATIVE

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Continued from 9099-C
Interviews with eight (8) staff revealed that all staff have not observed roaches in the facility. Two (2) out of the (8) staff interviewed stated that the facility may be malodors when staff are cleaning sheets of residents who had a heavy bladder or bowel movement, but staff are quick to remove the foul linen so the smell does not linger for too long. In addition, records review revealed, that the pest control conducts general treatment of rooms and commons areas at least every other week. Since May 2024, there have been ten (10) visits conducted by pest control company with one (1) visit in May the pest control company discovered a minor activity of roaches under a sink in the kitchen. Since May there has not been another visit where roach activity was found. Records review of daily room cleaning assignment logs revealed that trash containers are emptied and floors are mopped every day. Then twice a week the furniture is dusted, mirrors are cleaned, windows are cleaned, towels are replaced, and bathrooms are cleaned. During physical plant, LPA did not observe any foul odors or roaches. 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 ensure that facility is clean" is deemed Unsubstantiated at this time.

It was reported that “Staff do not ensure that fire exits are free of obstruction” as it was alleged that fire exits are always blocked by wheelchairs and walkers. Interviews conducted with ten (10) residents revealed that all (10) residents have never observed fire exists blocked by wheelchairs, walkers or any other objects. Interview eight (8) staff revealed that six (6) out of the (8) staff interviewed have never observed any exits obstructed by any object. Two (2) out of the (8) staff interviewed that when medications are passed out residents line up outside of the medication room and there are multiple residents with wheelchairs and walkers, but there is always a clear path to walk to the nearest exits in the event of an emergency. During physical plants, LPA did not observe any exits obstructed by wheelchairs, walkers or other objects. . 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 ensure that fire exits are free of obstruction " 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: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC9099 (FAS) - (06/04)

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