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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425801734
Report Date: 04/26/2023
Date Signed: 04/26/2023 04:26:14 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
03/29/2023 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20230329134815
FACILITY NAME:OANI HOME CARE FOR THE ELDERLY, INC.FACILITY NUMBER:
425801734
ADMINISTRATOR:SHIRLEY C. OANIFACILITY TYPE:
740
ADDRESS:936 N. SENECA STREETTELEPHONE:
(805) 354-0983
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:6CENSUS: 6DATE:
04/26/2023
UNANNOUNCEDTIME BEGAN:
03:55 PM
MET WITH:Shirley Oani, Administrator/LicenseeTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not keep pressure injury free from ants
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Olson conducted an unannounced subsequent complaint visit to issue final findings on the allegation above. LPA Olson interviewed reporting party on 3/30/23 and Staff on 4/26/23. LPA Chavez interviewed Administrator and resident on 4/3/23 and requested relevant documents. LPA Olson met with Administrator and explained the purpose of the visit.

On the allegation: Staff did not keep pressure injury free from ants. It was alleged that on 3/26/23 Resident 1 (R1) had a pressure injury and a witness observed a trail of ants going from the corner of the room, up the bed, and into R1’s wound. Witness stated they notified the administrator and there was no vacuum or bug spray but was given Lysol and sprayed as many ants as they could on the bed, and tried to clean off as many ants they could from the wound and the resident. The witness stated in their opinion, the Administrator didn’t seem bothered or care that there were so many ants on the resident or in their wound. Interview with the Administrator revealed that R1 moved in on 3/5/23. Administrator stated on 3/26/23 someone observed ants on Resident 1 and showed the Administrator. Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
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 2
Control Number 29-AS-20230329134815
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: OANI HOME CARE FOR THE ELDERLY, INC.
FACILITY NUMBER: 425801734
VISIT DATE: 04/26/2023
NARRATIVE
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 Administrator stated there were “two ants” on the residents’ sheets and they changed them immediately. Administrator also sprayed the room near the door and had not seen ants since. LPA Chavez Interviewed a new resident who now resides in R1’s room who stated they have seen an ant in their room but can’t remember if it happened more then once, and stated they didn’t tell staff. On 4/3/23 LPA Chavez did not observe any ants in the room, near the door or window where R1 resided.

LPA Olson toured the facility on 4/26/23 and did not observe any ants in the room. LPA interviewed Staff on 4/26/23. Staff stated there were only ants on R1's sheets but not on the resident and they did not observe any ants that week on or near the resident.

Based on the information obtained the allegation: Staff did not keep pressure injury free from ants is Unsubstantiated. Technical Assistance was issued to instruct the Administrator on the importance of keeping the facility clean and free of ants.

Exit interview conducted, copy of the report was issued.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2