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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425800662
Report Date: 09/13/2024
Date Signed: 09/13/2024 03:44:41 PM

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
04/10/2023 and conducted by Evaluator Kristin Kontilis
COMPLAINT CONTROL NUMBER: 29-AS-20230410085101
FACILITY NAME:VILLA BLANCAFACILITY NUMBER:
425800662
ADMINISTRATOR:INNA LYUTKO & NONNA ROZHKOFACILITY TYPE:
740
ADDRESS:6272 AVENIDA GANSOTELEPHONE:
(805) 683-2000
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:6CENSUS: 6DATE:
09/13/2024
UNANNOUNCEDTIME BEGAN:
10:49 AM
MET WITH:Nonna Rozhko, AdministratorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff do not meet residents' incontinence needs.
Staff did not answer resident's call button in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kristin Kontilis conducted a subsequent complaint visit to deliver final findings for the above allegation. At the time of arrival, LPA was greeted by Staff 1 (S1). During today’s visit, LPA met with Nonna Rozhko, Administrator and explained the purpose of the visit. The initial visit was conducted on 4/14/2023 from 12:15pm to 3:00pm by LPA Kristin Kontilis. LPA toured the facility, interviewed staff, and obtained relevant documents. LPA conducted a subsequent visit on 5/15/2024 from 9:30am to 4:15pm. LPA conducted interviews with residents, staff, and Licensee/Administrator between 12:05 pm and 2:35 pm and obtained additional documents. LPA also interviewed staff and residents during today’s visit.
On the allegations: Staff do not meet residents' incontinence needs and Staff did not answer resident's call button in a timely manner. It was alleged a resident was left on the toilet for over 35 minutes before a caregiver answered their call button because they did not hear the call. The reporting party also stated staff took over 30 minutes to answer the call button on another occasion. It was alleged a caregiver left a resident soiled for 24 hours during the night shift. All three witnesses interviewed confirmed a resident had stated
Please continue to 9099-C, Pg 2.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
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-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: 09/13/2024
NARRATIVE
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to them around April 2023 that the resident had had to wait a long time for assistance going to the bathroom. One witness stated they were present when the resident was waiting for help, which was approximately at least a half hour, and the witness left before the resident received assistance. Another witness stated the resident frequently complained about the long wait times for assistance getting out of bed and going to the restroom, sometimes waiting an hour for staff to come. Another witness stated the staff later provided the resident a commode but would not provide the resident assistance with it. One witness stated regarding the call buttons that the resident stated they had to wait a “long, long time” for staff to provide assistance. Staff interviewed stated they regularly check incontinent residents every 2-3 hours, and assist residents every 2-4 hours to the bathroom.
LPA reviewed a current shower log from 5/1/2024 through 9/13/2024. The log reflects residents received showers at least once each week. Administrator stated staff sometimes get busy and do not always record when a resident has had a shower. Administrator further stated that three of the six residents are currently on hospice and hospice provides a bed bath and/or shower with facility staff assisting hospice personnel. Administrator stated residents are provided sponge baths, linen change, and showers on an as needed basis and the lack of odorous smells is indicative of providing proper care to the residents.
Staff also stated they respond timely to residents call buttons but could not provide any logs for the response times. One resident interview revealed residents are responded to right away. Another resident stated the staff cannot hear the resident if they call for them because the room is soundproof. Therefore, the resident must rely on staff to check on them from time to time. Other residents were unable to state whether their call buttons or bells are answered timely. Based on the consistent information provided over a year after the initial allegations were made, the allegations are deemed Substantiated at this time.

The following deficiencies were observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in additional civil penalties.

Exit interview conducted. Copy of report and appeal rights at the time of the visit.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2024
Section Cited
CCR
87468.2(a)(4)
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87468.2(a)(4) Personal Rights…Residents in privately operated residential care facilities for the elderly shall have all of the following personal rights…To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.:
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Licensee agrees to submit a written statement acknowledging 87468.2 in its entirety. Written statement will be sent directly to LPA via email by POC due date.
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This requirement was not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above when residents had to wait to have call buttons responded to to meet their toileting needs, which posed a potential health and safety 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: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
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
04/10/2023 and conducted by Evaluator Kristin Kontilis
COMPLAINT CONTROL NUMBER: 29-AS-20230410085101

FACILITY NAME:VILLA BLANCAFACILITY NUMBER:
425800662
ADMINISTRATOR:INNA LYUTKO & NONNA ROZHKOFACILITY TYPE:
740
ADDRESS:6272 AVENIDA GANSOTELEPHONE:
(805) 683-2000
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:6CENSUS: 6DATE:
09/13/2024
UNANNOUNCEDTIME BEGAN:
10:49 AM
MET WITH:Nonna Rozhko, AdministratorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff handle residents in a rough manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kristin Kontilis conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA met with Nonna Rozhko, Administrator and explained the reason for the visit. The initial visit was conducted on 4/14/2023 from 12:15pm to 3:00pm by LPA Kristin Kontilis. LPA toured the facility, interviewed staff and obtained relevant documents. LPA conducted a subsequent visit on 5/15/2024 from 9:30am to 4:15pm. LPA conducted interviews with residents, staff, and Licensee/Administrator between 12:05 and 2:35 pm and obtained additional documents. LPA also interviewed staff and residents during today’s visit. LPA interviewed three witnesses on 8/19/2024 and 9/3/2024.
On the allegation: Staff handle residents in a rough manner. It was alleged a caregiver handled a resident roughly while assisting a resident with toileting by yanking them up by their arm. It was also alleged staff were rough when changing residents’ briefs. Resident interviews did not indicate any rough treatment by staff.

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: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
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-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: 09/13/2024
NARRATIVE
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Staff interviewed denied roughly handling residents at any time. Witnesses interviewed stated they did not observe or hear about any rough handling of residents. Although the allegation may have occurred, there was insufficient evidence to prove the allegation. Therefore it 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: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5