197607726-5-28-2025-31-AS-NGID-DL5NJT-20250902103044

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607726
Report Date: 05/28/2025
Date Signed: 05/28/2025 04:59:09 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/11/2024 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20241211135010

FACILITY NAME:	WILLIAM J. "PETE" KNIGHT VETERANS HOME-LANCASTER		FACILITY NUMBER:	197607726
ADMINISTRATOR:	EDINA LEMUS		FACILITY TYPE:	740
ADDRESS:	45221 30TH STREET WEST		TELEPHONE:	(661) 974-7035
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY:	60	CENSUS: 37	DATE:	05/28/2025
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Wendi Doyon / Assistant Administrator		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Resident rooms are unsanitary.
Resident visitors are not allowed to visit privately.
Staff is opening residents mail.

INVESTIGATION FINDINGS:

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On 05/28/25, Licensing Program Analyst (LPA) Evelin Rios arrived at the facility mentioned above for an subsequent complaint visit. LPA was greeted by security and asked to sign in. LPA met with the Assistant Administrator, Wendi Doyon and Executive Secretary I, Nanci Alvarado. LPA explained the purpose of the visit. Entrance interview conducted. LPA requested a copy of the resident roster and personnel report.

To investigate the allegations LPA Rios conducted an initial complaint visit on 12/16/24 in conjunction with an Annual Required visit. On 12/16/24 from 10:30 a.m. to 12:00 p.m., LPA conducted a physical plant tour of the facility with Agnieszka Sibbitt, the Supervisory Registered Nurse. At approximately 4:07 p.m., LPA obtained a copy of the facility's policies. LPA interviewed administrator at 4:33 p.m. On 04/14/25 LPA Rios conducted an an annual continuation visit, during that visit LPA toured two (02) bedrooms and interviewed two (02) residents. On today's visit LPA Rios interviewed seven (07) residents, the assistant administrator and five (05) staff.
(Continue to LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025

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 31-AS-20241211135010

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: WILLIAM J. "PETE" KNIGHT VETERANS HOME-LANCASTER	FACILITY NUMBER: 197607726
	VISIT DATE: 05/28/2025

NARRATIVE

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Allegation: Resident rooms are unsanitary. In regards to the allegation is was reported that two (2) rooms are unsanitary. On 04/14/25 during an annual continuation visit LPA toured the two (02) rooms reported in the allegation. LPA observed both rooms where the residents bed is to be cluttered with residents' personal belongings such as unopened drinks and food on the floor and on furniture surfaces. Both rooms bathrooms were observed clean and clear of clutter. LPA's interview with resident #1 (R1) and resident #2 (R2), confirmed that housekeeping regularly visits their room to clean. Interview with R1 revealed they direct staff to clean around their belongings without moving them. Interview with R2 revealed they decline cleaning services and admitted to the LPA that they may become hostile with staff when they enter the room to clean. Interview with seven (07) residents on 05/28/2025 state that housekeeping is regularly cleaning their rooms and have no concerns regarding the cleanliness of their bedrooms. On 12/16/24, LPA toured three (03) shared rooms and on 05/28/2025 toured two (02) shared rooms. LPA observed the rooms to be clean and sanitary. Interview with one (01) housekeeping staff on 05/28/25 revealed they clean rooms every day and has experienced reluctance specifically from R2 but per management direction they are working on engaging with the resident in order to be able to clean the room more often. Interview with the administrator on 12/16/24, the Administrator is aware of the resident’s refusal and continues to engage in ongoing discussions regarding their preferences. Although the bedrooms mentioned in the allegation were observed with items cluttering surfaces, the residents residing in the rooms informed LPA they refused cleaning services. Based on interviews the allegation is deemed Unsubstantiated at this time.

Allegation: Resident visitors are not allowed to visit privately. In regards to the allegation it was reported that management has been having the residents’ visitors escorted for the entire visit. LPA's interview with the administrator on 12/16/24 informed LPA visitors are allowed in resident's bedrooms and outside if they wish to meet residents in private. Interview with five (05) out of the nine (09) total residents interviewed on 04/14/25 and 05/28/25 that stated they have visitors in the facility did not corroborate the allegation. Interview with Residents' revealed no issues or concerns regarding meeting visitors in private such as in their room. Interview with five (05) staff on 05/28/2025 denied the allegation. LPA was unable to find corroborating evidence to the allegation. Based on interviews the allegation is deemed Unsubstantiated at this time.

(Page 2 of 3 Continue to LIC9099-C)

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 31-AS-20241211135010

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: WILLIAM J. "PETE" KNIGHT VETERANS HOME-LANCASTER	FACILITY NUMBER: 197607726
	VISIT DATE: 05/28/2025

NARRATIVE

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Allegation: Staff is opening residents mail. In regards to the allegation is was reported that resident's mail is being opened before the resident is informed. LPA's interview with two (02) out of nine (09) residents interviewed on 12/16/24 and 05/28/25 revealed they had issues regarding their mail. Interview with Resident #3 (R3) revealed a few years ago they had retrieved a letter from their mail box and it appeared to have been slightly open from one corner. However, R3 was not sure if it was an issue with the mail person or the staff in the facility. Interview with Resident #4 (R4) revealed they had new medication mailed to them and it was held at the medication room. According to R4 the nurse was going to open the package in front of them. Interview with the administrator on 12/14/25 revealed the mail is left with the security guard and they place the mail into residents' mailboxes and the only time they would hold a delivery is when there may be medication in the package. Staff are directed to open the package in front of the resident in order to document medication and centrally store medication if needed. Interview with one (01) Licensed Vocational Nurse corroborated the procedure for handling medication delivers going into further detail if new medication arrives they will call the resident's doctor to confirm the medication or receive a prescription for it to place on file. Interview with the other seven (07) seven residents did not corroborate the allegation stating they have no issues or concern regarding their mail. Based on interviews the allegation is deemed Unsubstantiated at this time.

No deficiencies issued. Exit interview. Report signed and delivered.

(Page 3 of 3 Continued from LIC9099-C)

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025

LIC9099 (FAS) - (06/04)

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