195850339-4-22-2025-29-AS-KLOZ-DG8UJ5-20250430153657

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850339
Report Date: 04/22/2025
Date Signed: 04/22/2025 05:46:13 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
02/12/2025 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20250212142037

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: 160	DATE:	04/22/2025
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Rose Anguiano		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff are not ensuring that resident's special diet is adhered to while in care.
Licensee retained a resident with a higher level of care need.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to deliver investigation finding. Upon arrival LPA met with Administrator Rose Anguiano. The reason for the visit was explained.

On 02/12/2025, Community Care Licensing Division received the above allegations. On 02/18/2025, LPA conducted the initial complaint visit. Between 10:30am - 11:45am, LPA reviewed and obtained copies of pertinent documents relevant to the investigation. At approximately 1pm-2pm, interviews were conducted with eight (8) residents. At approximately 2:30pm LPA conducted interview with staff. Attempts made to reach the reporting party on 02/18/2025, 02/20/205 and 04/21/2025.

Following is a summary of the allegations and investigation finding: Regarding allegation - Staff are not ensuring that resident's special diet is adhered to while in care. It was reported that resident #1 (R1) is diabetic and the facility is serving regular meals; not ensuring R1 is provided a diabetic diet.(Cont.LIC9099c)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025

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-20250212142037

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: 04/22/2025

NARRATIVE

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Interview conducted with R1, staff and records reviewed confirmed that R1 is alert x3 and able to make own decisions; records reviewed noted that R1 is T2DM; physical report indicates R1 should follow special diet for T2DM. R1 confirmed being able to monitor and check own glucose level. R1 confirmed facility offers diabetic meals however R1 does not like it therefore, is not consistent with maintaining a diabetic diet. Staff interviewed confirmed R1 is able to handle own medications and make decisions for all ADLs at this time.
Random residents interviewed reported being satisfied with the facility food service at this time.

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 “Staff are not ensuring that resident's special diet is adhered to while in care” is deemed unsubstantiated at this time.

Regarding Allegations - Licensee retained a resident with a higher level of care need.:
It was reported that R1’s glucose was not checked and facility staff reported that as an assisted living facility, they do not follow medical recommendations, and they are not equipped to check glucose.
Interview with staff, R1 and records reviewed revealed that R1 manages own medications and is also able to check own glucose if needed. R1 confirmed that if needed staff are there to assist with medications however at this time R1 manages own medications. Staff interviewed confirmed that at this time R1 handles own meds however will be re-evaluated at the next assessment date to confirm continued med-management by R1 is appropriate. R1 expressed that as result of having too many medications R1 is considering being on facility med-management program. Random resident interviewed expressed that staff provide care services and manage medication accordingly. No issues reported by residents.

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 “Licensee retained a resident with a higher level of care need“ is deemed unsubstantiated at this time.

Exit interview held, appeal rights and copy of report provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025

LIC9099 (FAS) - (06/04)

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