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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425850353
Report Date: 08/23/2024
Date Signed: 08/28/2024 03:41:54 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 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
04/15/2024 and conducted by Evaluator Brian Phillips
COMPLAINT CONTROL NUMBER: 29-AS-20240415163235
FACILITY NAME:OLIVE GROVE RESIDENTIAL CARE HOMEFACILITY NUMBER:
425850353
ADMINISTRATOR:CASTILLO, MARIBELFACILITY TYPE:
740
ADDRESS:1510 CALLE MIROTELEPHONE:
(805) 710-5304
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:6CENSUS: 1DATE:
08/23/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Maribel Castillo, Licensee/AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff caused injury to resident.
Staff does not maintain a comfortable room temperature for resident.
Staff sleeping while on duty.
Staff tells resident to disrupt another resident’s sleep.
INVESTIGATION FINDINGS:
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On 08/23/2024, Licensing Program Analyst (LPA) Brian Phillips conducted a subsequent complaint investigation visit to the facility above to deliver final findings for the above allegations. During today’s visit, LPA Phillips met with Licensee/Administrator Maribel Castillo, and explained the reason for the visit.

On the allegation: Staff caused injury to a resident. It is alleged that a visitor to the facility observed that the ear of Resident #1 (R1) was black and blue. Allegedly the visitor inquired about the ear of R1 and staff stated it was from cleaning R1’s ear. R1 was asked about what happened to their ear but they did not know. It is also alleged that the facility staff allow R1 to use their wheelchair as a walker. Allegedly staff were informed by the responsible party of R1 that it is unsafe to use their wheelchair as a walker.

Staff interviewed by LPA on 04/17/2024 stated that relatives of R1 were complaining about the level of care, but R1 had improved while in care at the facility. Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
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 4
Control Number 29-AS-20240415163235
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: OLIVE GROVE RESIDENTIAL CARE HOME
FACILITY NUMBER: 425850353
VISIT DATE: 08/23/2024
NARRATIVE
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R1 stated that they were happy with the treatment in the facility and did not corroborate the statements made by complainant/Reporting Party (RP). Staff stated the facility is complying with giving R1 activities and treatment, Activities of Daily Living (ADL), as well as needs and services. On 04/17/2024, LPA conducted record review of relevant documentation of R1 to the allegation above. LPA reviewed the Resident Admissions Agreement, Medical Assessment/Physicians Reports, Appraisal Needs and Services Plan, and any relevant medical/hospital documentation that all outlined the need for R1 to have assistance from staff in ADLs such as bathing, grooming, and hygiene needs. Both staff of the facility and outside Agency representatives providing care to R1 stated that there was an attempted mediation with RP to ask what the facility can improve upon related to caring for R1, but RP did not have any specific answers. LPA received photographs that provided documentation of the redness/irritation to the top of R1’s ear. LPA observed that the ear of R1 appeared to be irritated/red but did not observe any bruising or any black or blue discoloration. According to staff interviewed by LPA, this redness on R1’s ear occurred during a cleaning of R1’s ears by staff members assisting with R1’s grooming/bathing/hygiene ADLs. All residents interviewed by LPA stated that they did not observe any mistreatment of R1 by any staff member and had never received any type of physical mistreatment by any staff member at the facility. Staff members and RP interviewed by LPA all stated that a previous meeting had been set up with the facility, in which there was anger at the fact that R1 was having trouble walking. Staff interviewed by LPA stated that R1 used a wheelchair in the correct capacity at the facility, and not as a walker. Residents interviewed by LPA stated that R1 was observed to be using a wheelchair while in the facility, but not as a walker just as a traditional wheelchair.

Based on the information obtained, there was insufficient evidence that staff do not maintain a comfortable room temperature for resident(s). Therefore, the allegation is deemed Unsubstantiated at this time.

On the allegation: Staff does not maintain a comfortable room temperature for resident. It is alleged that a visitor to the facility observed a blanket over the head of Resident #1 (R1) while in their bedroom. R1 allegedly told the visitor that they were cold. The visitor allegedly asked for staff to turn the facility heater on, but staff did not know how.

On 04/17/2024, LPA conducted an initial 10-day complaint investigation visit to the facility above. During this visit, the LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. LPA observed that the facility maintained a comfortable temperature in all common areas and resident bedrooms inspected. Continued on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20240415163235
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: OLIVE GROVE RESIDENTIAL CARE HOME
FACILITY NUMBER: 425850353
VISIT DATE: 08/23/2024
NARRATIVE
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LPA observed a thermostat in the main facility living room area which was observed to be at 72 degrees Fahrenheit at the time of visit by LPA. On 08/23/2024, LPA conducted a subsequent complaint investigation visit to the facility above. During this visit, LPA observed that the facility maintained a comfortable temperature in all common areas and resident bedrooms inspected. LPA did not physically observe an uncomfortable temperature in the facility at the time of either visit, whether it be observably cold or observable hot. All residents interviewed by the LPA indicated that they had no problems with the temperature maintained by the facility and were comfortable in care. All Staff members interviewed by the LPA indicated that they had not had any residents ask to change the temperature in the facility, either to ask for air conditioning or to have a heater turned on. While at the facility on 04/17/2024, LPA asked staff to demonstrate how to use the thermostat and facility heater. Staff members were able to adequately demonstrate to LPA how to operate the facility temperature controls. No resident was observed by LPA during either visit (04/17/2024 or 08/23/2024) to be wearing blankets or sweaters/additional clothing in the facility or visibly uncomfortable due to excessive cold. No resident was observed by LPA during either visit to be sweating or visibly uncomfortable due to excessive heat.

Based on the information obtained, there was insufficient evidence that staff do not maintain a comfortable room temperature for resident(s). Therefore, the allegation is deemed Unsubstantiated at this time.

On the allegation: Staff sleeping while on duty. It is alleged that a visitor to the facility asked Resident #1 (R1) where a facility staff member was and was informed that the staff member was sleeping. It is alleged that R1 refuses to sleep on the bed in their bedroom and prefers to sleep on the recliner in the facility living room, while a staff member sleeps on the couch. It is alleged that R1 called their responsible party by telephone stating that they were hungry and that a staff member was sleeping. This telephone call allegedly took place at 10:00am. R1 was informed that they should wake the staff member. After the staff member allegedly woke up, they refused to speak with the responsible party of R1.

Staff interviewed by LPA stated that R1 sleeps on the couch sporadically when watching television but uses their bedroom to sleep at night. Residents interviewed by LPA corroborated this statement and added that R1 was observed by other residents to go into their bedroom at night to sleep. No staff member or resident interviewed by LPA stated that they had ever observed a staff member sleeping on the couch in the common area living room of the facility while on duty. During unannounced and unscheduled visits by LPA on 04/17/2024 and 08/23/2024, no staff member was observed by LPA to be sleeping and/or laying on the couch in the living room of the facility or anywhere else in the facility. Continued on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20240415163235
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: OLIVE GROVE RESIDENTIAL CARE HOME
FACILITY NUMBER: 425850353
VISIT DATE: 08/23/2024
NARRATIVE
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Based on the information obtained, there was insufficient evidence that staff do not maintain a comfortable room temperature for resident(s). Therefore, the allegation is deemed Unsubstantiated at this time.

On the allegation: Staff tells resident to disrupt another resident’s sleep. A visitor to the facility stated they witnessed facility staff members asking Resident #1 (R1) to wake up Resident #2 (R2) for lunch.

On 04/17/2024, LPA received documentation for record review regarding the meal/food service schedule for the facility. This schedule is documented to have lunch for the facility residents in the afternoon approximately between 12pm-3pm. All facility staff members and residents interviewed by the LPA indicated that lunch is served in the afternoon and that if a resident does not know that lunch has been served, staff or other residents will let them know as a courtesy. No staff or resident interviewed by LPA indicated that any resident would be intentionally disrupted if they had requested or required privacy such as sleeping in their room. No resident interviewed by LPA stated that they had ever been forced to go wake up another resident for any reason, and no staff member interviewed by LPA stated that they had ever required or forced a resident to wake up another resident.

Based on the information obtained, there was insufficient evidence that staff do not maintain a comfortable room temperature for resident(s). Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. Copy of this report provided to the facility.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Brian Phillips
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4