425800662-5-16-2024-29-AS-KBUY-D9GULW-20240926154123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425800662
Report Date: 05/15/2024
Date Signed: 05/16/2024 03:32:06 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
04/10/2023 and conducted by Evaluator Kristin Kontilis

COMPLAINT CONTROL NUMBER: 29-AS-20230410085101

FACILITY NAME:	VILLA BLANCA		FACILITY NUMBER:	425800662
ADMINISTRATOR:	INNA LYUTKO & NONNA ROZHKO		FACILITY TYPE:	740
ADDRESS:	6272 AVENIDA GANSO		TELEPHONE:	(805) 683-2000
CITY:	GOLETA	STATE: CA	ZIP CODE:	93117
CAPACITY:	6	CENSUS: 5	DATE:	05/15/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Inna Lyutko, Administrator/Licensee		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff yell at residents.
Staff confine residents in their rooms.
Staff did not provide resident with housekeeping service.
Staff do not meet residents' dietary needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kristin Kontilis conducted a subsequent complaint visit to deliver findings for the above-stated allegations. LPA met with Inna Lyukto, Licensee/Administrator and explained the purpose of the visit. During the investigation, LPA conducted interviews with reporting party, staff, and residents. LPA obtained documents pertaining to the investigation.
During the initial investigation visit on 4/14/2023, LPA conducted interviews with staff between 12:15 pm and 3:00 pm. During today’s subsequent visit, LPA conducted interviews with residents, staff, and Licensee/Administrator between 12:05 and 2:35 pm and obtained additional documents.
On the allegation, Staff yell at residents: Observations made and interviews conducted revealed residents have difficulty hearing at a regular voice volume. Staff 1 (S1) stated they may sound loud, but is not loud and not intended to yell.” LPA observed S1’s voice to project clearly and in a positive and “matter of fact” manner. Licensee also stated residents have difficulty hearing at a regular voice volume and some residents
Please continue to 9099-C, Pg 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

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-20230410085101

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: VILLA BLANCA	FACILITY NUMBER: 425800662
	VISIT DATE: 05/15/2024

NARRATIVE

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more than others. During interviews with residents, residents demonstrated difficulty hearing LPA during interviews. Additionally, LPA observed S1 complimenting residents throughout LPA’s visit. Observations made and interviews conducted, the allegation that staff yell at residents is deemed Unsubstantiated at this time.

On the allegation, Staff confine residents in their rooms: Upon LPA’s visit to the facility on 4/14/2023 and 5/26/2023, LPA observed five (5) residents in the living room upon LPA’s arrival. On today’s visit, LPA observed four (4) residents in the living room upon LPA’s arrival. Interviews conducted revealed residents are free to exercise their choice of whether they want to be in their room or be out in the common area. Interviews revealed Resident 1 (R1), Resident 2 (R2), Resident 3 (R3) and Resident 4 (R4) frequently sit in the living room after breakfast and through lunch. Interviews conducted further revealed Resident 5 (R5) prefers to stay in their room throughout the day and into the night; R5 does not like TV or music and prefers a very quiet environment; R5 regularly eats all meals in their room by R5’s choice. Licensee stated R5 is adamant about R5’s quiet environment. Based on observations made and interviews conducted, the allegation that staff confine residents in their rooms is deemed Unsubstantiated at this time.

On the allegation, Staff did not provide resident with housekeeping service: Upon LPA’s visit to the facility on 4/14/2023 and 5/26/2023, LPA noted and observed the facility to be clean, odorless, and in good repair. During today’s visit, LPA observed the facility to be clean, odorless, and in good repair. Interviews conducted revealed staff change the bedding at least once a week and on an as needed basis; Staff on duty are caregivers who change bedding and observe any housekeeping needs; floors are cleaned (swept and washed) every day; trash is taken out several times each day; windows and screens are cleaned on a regular basis; and bathrooms are cleaned every day. Interviews conducted further revealed Staff 2 (S2) conducts a “deep” cleaning on S2’s regularly scheduled shift twice each week. Staff interviews revealed S2 is very diligent about the cleanliness of the facility when on duty. Based on observations made and interviews conducted, the allegation that Staff did not provide resident with housekeeping service is deemed Unsubstantiated at this time.

Please continue to 9099-C, Pg 3.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230410085101

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: VILLA BLANCA	FACILITY NUMBER: 425800662
	VISIT DATE: 05/15/2024

NARRATIVE

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On the allegation, Staff do not meet residents' dietary needs: Interviews conducted revealed residents are not on a special diet and do not require food to be blended. Licensee stated if a resident is prescribed a special diet, the facility will meet the resident's dietary needs. Interviews conducted revealed the meal items are rotated throughout the week and month—meaning meats, chicken, fish, eggs, fresh fruit, and fresh vegetables are served in variety and all meals including pastas and soups are primarily made from scratch. Interviews conducted revealed residents eat all of their meal most of each mealtime. Interviews conducted revealed staff will honor a resident’s special request for a meal or a particular food item. LPA obtained the facility meal log from dates 4/7/2023 through 4/14/2023 and 5/8/2024 through 5/15/2024. Breakfast meals prepared in the facility and served to residents on different dates consisted of oatmeal, fruit, juice, coffee; waffles, fruit, sausage, juice; eggs with ham, fruit, toast, coffee/juice; cereal, milk, fruit, juice, water, coffee; eggs, spinach, tomato, spam; and eggs, link sausage, cake, fruit, juice, coffee, tea. Lunch meals prepared in the facility and served to residents on different dates consisted of soup, sandwich, juice; chicken sandwich with lettuce and tomato, water, juice, cake; chicken salad sandwich with celery, carrot, shredded cheese, soup, juice, water; grilled cheese, juice; soup, tuna sandwich, juice; soup, hot dogs, juice; chicken, potato salad, rice, cookies, water; pasta salad w/ham and vegetables soup, water; and bean soup, mushrooms, meat pie. Dinner meals prepared in the facility and served to residents on different dates consisted of ground beef, vegetables, mashed potatoes; alfredo pasta, vegetables, salad, cookies, juice; ham, vegetables, pasta, juice, apple pie; beef, vegetables, salad, juice, water, jello; fish, rice, vegetables, juice, apple pie; spaghetti with ground beef, salad, oatmeal cream pie, water; ravioli, vegetables, salad, water, ice cream; and fish, vegetables, coleslaw, salad, water, and brownies. Based on record review and interviews conducted the allegation that staff do not meet dietary needs is deemed Unsubstantiated at this time.

Exit interview conducted. No deficiencies noted. Copy of report issued at the time of the visit.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

LIC9099 (FAS) - (06/04)

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