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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405850052
Report Date: 10/07/2024
Date Signed: 10/07/2024 09:21:18 AM

Substantiated


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
07/15/2024 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20240715084408
FACILITY NAME:PARK PLACE ASSISTED LIVINGFACILITY NUMBER:
405850052
ADMINISTRATOR:BARNHILL, DIANAFACILITY TYPE:
740
ADDRESS:7500 PORTOLA RDTELEPHONE:
(805) 591-9855
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:13CENSUS: 10DATE:
10/07/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:BOM, Letica Ruiz-GuerreroTIME COMPLETED:
11:31 AM
ALLEGATION(S):
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Staff did not treat residents with respect
INVESTIGATION FINDINGS:
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 At 9:30am on 10/07/2024, Licensing Program Analyst (LPA) Jeffrues conducted a subsequent complaint visit to issue final findings on this investigation. LPA met with BOM, Letica Ruiz-Guerrero and explained the purpose of the visit. During the investigation, LPA De Leon conducted an initial visit on 7/22/2024 from 10:15am to 3:15pm, where LPA toured the facility, interviewed staff and residents and requested documents. Additional interviews with witness, Administrator and staff were conducted on 10/3/2024.

On the allegation: Staff did not treat residents with respect. It was alleged residents cry due to being yelled at by staff. Multiple residents interviewed stated they were treated “fine,” “well,” “very well,” and said there was no yelling or disrespect. One resident stated a staff was disrespectful. Staff stated they never yell at residents, and treat residents with respect. Administrator stated staff have never yelled or been disrespectful, and they would not tolerate that behavior from staff. A credible witness was interviewed who stated they had never witnessed or heard of staff yelling at the residents, but had consistently heard and/or witnessed staff are rude or mean to residents. CONTINUED on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2024
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 5
Control Number 29-AS-20240715084408
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: PARK PLACE ASSISTED LIVING
FACILITY NUMBER: 405850052
VISIT DATE: 10/07/2024
NARRATIVE
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Witness indicated one resident stated some staff are kinder than others. Administrator stated one resident does not want to be at the facility so they complain about a lot of things. Based on the information obtained, the allegation is deemed Substantiated at this time.

Exit interview, deficiencies cited on 9099-D, report given, appeal rights given.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20240715084408
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: PARK PLACE ASSISTED LIVING
FACILITY NUMBER: 405850052
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/21/2024
Section Cited
CCR
87468.1(a)(1)
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87468.1(a)(1) Personal Rights. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews,
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POC: Administrator agrees to hold personal rights from a third-party vendor for all staff and submit proof of completion by 10/21/2024.
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the licensee did not comply with the section cited above when residents were not treated with respect, which posed a potential personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
07/15/2024 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20240715084408

FACILITY NAME:PARK PLACE ASSISTED LIVINGFACILITY NUMBER:
405850052
ADMINISTRATOR:BARNHILL, DIANAFACILITY TYPE:
740
ADDRESS:7500 PORTOLA RDTELEPHONE:
(805) 591-9855
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:13CENSUS: DATE:
10/07/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:TIME COMPLETED:
11:31 AM
ALLEGATION(S):
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9
Staff did not comply with infection control requirements.
INVESTIGATION FINDINGS:
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 At 9:30am on 10/07/2024, Licensing Program Analyst (LPA) Jeffries conducted a subsequent complaint visit to issue final findings on this investigation. LPA met with BOM, Letica Ruiz-Guerrero and explained the purpose of the visit. During the investigation, LPA De Leon conducted an initial visit on 7/22/2024 from 10:15am to 3:15pm, where LPA toured the facility, interviewed staff and residents and requested documents. Additional interviews with witness, Administrator and staff were conducted on 10/3/2024.

On the allegation: Staff did not comply with infection control requirements. It was alleged staff were made to work while being diagnosed with COVID-19. Staff interviewed stated they comply with Health Department requirements. At the time of interview on 7/22/2024, the last outbreak was 11/24/2023 with one staff. The staff had no symptoms of COVID-19 and when they came back to work, they work a mask, gloves and practiced proper handwashing. Staff interviewed stated all staff comply with proper glove usage and mask wearing where appropriate. Administrator stated staff that had COVID-19 with symptoms including fever did not work. CONTINUED on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20240715084408
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: PARK PLACE ASSISTED LIVING
FACILITY NUMBER: 405850052
VISIT DATE: 10/07/2024
NARRATIVE
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If they were positive asymptomatic, they were allowed to work with positive residents in alignment with local health department guidelines. Administrator stated they contact public health for every COVID-19 case or exposure for guidance, and take infection control seriously. No infection control issues were observed during the visits. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

Exit interview, report given.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5