195850339-9-26-2024-29-AS-DPEA-DAHPX6-20241029114150

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850339
Report Date: 09/26/2024
Date Signed: 09/26/2024 11:12:15 AM

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
08/01/2024 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20240801124831

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: 172	DATE:	09/26/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Rose Anguiano - Administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility staff not assisting resident with ambulating as needed
Facility staff not meeting resident’s showering needs
Facility staff not meeting resident’s need for clean clothing
Facility staff not meeting resident’s grooming needs
Facility staff not ensuring resident’s diabetic needs are met
Facility staff not seeking appropriate medical attention for resident
Facility staff not maintaining the facility free of odor
Facility staff not maintaining passageways free of obstruction
Facility staff not maintaining the facility clean

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit. The purpose of the visit is to deliver final findings to a complaint initiated by LPA Z. Chochian on 08/06/2024. Upon arrival LPA met with Rose Anguiano and the reason for the visit was explained.

On 08/06/2024, LPA Z. Chochian conducted an initial 10-day complaint visit and conducted a physical plant tour which included random resident rooms, common areas, and laundry rooms. From approximately (approx.)11 a.m. - 2:30 p.m., LPA interviewed fifteen (15) residents and three (3) staff. Between 2:45 p.m.-3:45 p.m. LPA reviewed four (4) resident records and conducted interview with med-tech staff.

Following is a summary of the allegations and investigation finding:

Regarding allegation “Facility staff not assisting resident with ambulating as needed”: It was reported that facility staff are not assisting resident #1 (R1) with ambulating

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

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-20240801124831

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: 09/26/2024

NARRATIVE

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Continued from 9099
Interviews conducted with staff and R1 revealed that although R1 is partially blind, R1 ambulates with a walker and can leave facility unassisted. R1 confirmed being able to ambulate without staff assistance however reported R1 could benefit from staff assistance to prevent falls. Records reviewed revealed that R1 was recently admitted to the facility and the preadmission appraisal and assessment conducted by facility staff did not indicate that R1 requires assistance in ambulating. Furthermore, records reviewed and interview with R1 revealed that R1 did not sustain any falls since admission. Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Facility staff not assisting resident with ambulating as needed” is deemed UNSUBSTANTIATED at this time.

Regarding Allegations “Facility staff not meeting resident’s showering needs, Facility staff not meeting resident’s need for clean clothing, and Facility staff not meeting resident’s grooming needs”: It was reported that R1 is supposed to get help bathing several times a week but reported that R1 only gets a shower from the facility every two weeks. It was also reported that R1 was observed wearing dirty clothes and had long nails. R1 was interviewed and did not recall how often staff provide bathing assistance. Facility’s Resident bathing schedule reviewed showed that R1 is scheduled for 2 showers a week. According to Administrator and staff showers provided are not documented however if a resident refuses to shower it is documented. No record of R1 refusing showers. Regarding staff not meeting resident need for clean clothing. R1 was interviewed and did not express any concern with laundry services. R1’s was observed in clean clothing during visit; no dirty laundry observed in room. Staff reported that laundry is picked up daily from resident. Allegations was discussed with administrator and staff. In addition, random residents were interviewed. All residents interviewed stated there is sufficient staffing to meet their needs. Residents expressed that they are independent and don’t need assistance from staff. Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Facility staff not meeting resident’s showering needs, Facility staff not meeting resident’s need for clean clothing, and Facility staff not meeting resident’s grooming needs is deemed UNSUBSTANTIATED at this time.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20240801124831

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: 09/26/2024

NARRATIVE

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Continued from 9099-C

Regarding allegation “Facility staff not ensuring resident’s diabetic needs are met”: It was reported that R1 is a diabetic, however staff are not ensuring that his blood sugar levels are checked. Interview conducted with R1 revealed that they are not diabetic however would like their blood sugar tested to ensure glucose levels are normal. It was explained to R1 that facility staff are not allowed to do glucose checks and only a skilled professional or resident may conduct the glucose testing if needed. Staff interviewed and records reviewed did not reveal any order for glucose testing for R1. Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Facility staff not ensuring resident diabetic needs are met” is deemed UNSUBSTANTIATED at this time.

Regarding allegation “Facility staff not seeking appropriate medical attention for resident”: It was reported that that R2 has been coughing up blood and refuses to see a doctor. It was also reported that the staff at the facility has offered to take R2 to the hospital, but the R2 refuses to go get treated. Interview was conducted with R2. R2 denied ever coughing up blood. R2 confirmed hospitalization was due to nosebleed (a week ago). R2 did not report any issues with the facility and expressed that staff are very attentive. R2 expressed that everything is well and feels safe at facility. No other medical issue reported by R2. Staff interviews revealed that R2 did have a nosebleed a week ago and was sent out to the hospital for evaluation. R2 returned the same day with no new orders. Interview with staff and records reviewed revealed that R2 was TB cleared prior to admission and recently retested with a negative result. Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Facility staff not seeking appropriate medical attention for resident” is deemed UNSUBSTANTIATED at this time.

Regarding allegations “Facility staff not maintaining the facility free of odor, Facility staff not maintaining passageways free of obstruction and Facility staff not maintaining the facility clean”: It was reported that several rooms had a strong urine smell and trash next to the entry way of several rooms, one of which blocked a resident from exiting their room. During the initial visit, LPA toured the facility physical plant which included the hallways, random resident rooms, and common areas.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20240801124831

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: 09/26/2024

NARRATIVE

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Continued from 9099-C

Also, during the initial visit, LPA conducted interview with 15 residents. Hallways and resident rooms toured observed clean and odor free during visit. All passageways and exits observed free of obstruction. Residents interviewed did not report any issues with passageways being obstructed, facility cleanliness or any bad odor. Staff reported that if a resident has an accident in their room housekeeping is immediately called to clean. Staff stated that passageways are never obstructed, resident rooms are kept clean, and trash is picked up daily. Administrator expressed that it is a challenge with some residents who have a lot of items in their room. However, they offer to assist resident with organizing things in the room so that housekeeping can clean and have room free of any hazards and maintain room odor free. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegations or that a violation occurred; therefore, the allegations “Facility staff not maintaining the facility free of odor, Facility staff not maintaining passageways free of obstruction and Facility staff not maintaining the facility clean” is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. A copy of the report was provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC9099 (FAS) - (06/04)

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