195850339-5-29-2025-29-AS-KLOZ-DH74AH-20250530185558

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850339
Report Date: 05/21/2025
Date Signed: 05/29/2025 04:53:39 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
04/22/2025 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20250422113340

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:	05/21/2025
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Tina Hernandez, Resident Services Coordinator		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Lack of supervision resulting in resident being physically and verbally abused by another resident.

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 Tina Hernandez. The reason for the visit was explained.

On 04/22/2025, Community Care Licensing Division received the above allegation. On 04/30/2025, LPA conducted the initial complaint visit and allegation was discussed with Administrator. LPA toured the facility and met with approximately four (4) residents. Pertinent documents relevant to the investigation was obtained.

On 4/22/2025 during a subsequent complaint visit for another complaint LPA interviewed Resident #1 (R1). R1 did express wanting to move out; denied to state reason for move-out. R1 did express feeling safe at the facility and able to take care of self. R1 did not report any physical abuse with any other resident. LPA attempted to ask detailed questions regarding allegation however R1 expressed increasing agitation and refused to answer any further questions. (Continue to LIC9099c).

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

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-20250422113340

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: 05/21/2025

NARRATIVE

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On 5/21/2025, LPA conducted additional interviews with four (4) resident and three (3) staff from approximately 1:30pm 2:30pm.

Following is a summary of the allegation and investigation finding:

Allegation “Lack of supervision resulting in resident being physically and verbally abused by another resident.”: Information was provided that R2 has been verbally and physically abusive towards R1. It is reported that this has been ongoing for the past few months. Attempt was made to gather additional information about the reported verbal and physical abuse from the reporting party (RP). It was indicated that R2 had “laid hands on R1”. There were no reports of any related injuries, and it was not disclosed what R2 had said to R1. R1 denied being physically abused. R2 denied ever being physically or verbally abusive with R1 or any other resident. R2 expressed that R1 is very aggressive and is verbally abusive towards the residents and staff. R2 recalled an incident happening outside the facility last month with R1 and denied that there was any physical or verbal abuse. Staff interviewed denied the allegation. Staff stated that R1 did report having a verbal altercation with R2 on 04/22/2025 and 04/20/2025 outside the facility. According to staff no physical abuse was reported between R1 and R2. According to staff, R1 has some cognitive impairments and is easily agitated. Staff reported that R1 is usually aggressive and verbal abusive towards staff and other residents. Random residents interviewed did not observe any physical or verbal abuse between R1 and R2. Residents interviewed reported that anytime there is a physical or verbal altercation staff are present and either redirect or contact law enforcement.

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 “Lack of supervision resulting in resident being physically and verbally abused by another resident” is deemed Unsubstantiated at this time.

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

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

LIC9099 (FAS) - (06/04)

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