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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565800551
Report Date: 10/19/2021
Date Signed: 10/19/2021 04:09:32 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
10/11/2021 and conducted by Evaluator Joann Rosales
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20211011144616
FACILITY NAME:GABLES OF OJAI, THEFACILITY NUMBER:
565800551
ADMINISTRATOR:ERIC TERRILLFACILITY TYPE:
740
ADDRESS:701 N. MONTGOMERY ST.TELEPHONE:
(805) 646-1446
CITY:OJAISTATE: CAZIP CODE:
93023
CAPACITY:118CENSUS: 73DATE:
10/19/2021
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Eric TerrillTIME COMPLETED:
04:08 PM
ALLEGATION(S):
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Staff lied to residents authorized representative regarding services provided by the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) JoAnn Rosales made an unannounced complaint visit to this facility for the above complaint allegation. LPA met with Administrator Eric Terrill.

During today's complaint investigation LPA toured the facility with the Administrator, interviewed random residents and staff, and obtained pertinent documents. Concerns were that the Administrator lied to resident #1 (R1's) authorized representative regarding (CCL) Community Care Licensing mandating 1:1 caregiving services for R1. Interview with Administrator starting at 3:16 pm revealed that CCL did not mandate 1:1 caregiving services for R1. Administrator stated that based on R1 physicians report indicating R1 is not able to leave the facility unassisted and R1 authorized representative refusing memory care after R1 left the facility unassisted 1:1 caregiving was the only option. Administrator stated that telling R1's authorized representative that CCL mandated 1:1 caregiving services was the wrong choice of words. Based on the information
Continued on 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Joann Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021
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-20211011144616
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: GABLES OF OJAI, THE
FACILITY NUMBER: 565800551
VISIT DATE: 10/19/2021
NARRATIVE
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obtained during the course of the investigation the allegation is deemed substantiated at this time.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D).

Exit interview conducted. Today's reports and appeal rights were reviewed and emailed to the Administrator.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Joann Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Citations on this Visit Report are Under Appeal!

Control Number 29-AS-20211011144616
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: GABLES OF OJAI, THE
FACILITY NUMBER: 565800551
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
10/29/2021
Section Cited
CCR
87207
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87207 False Claims No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility.

This requirement is not met as evidenced by:
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Administrator stated that they will provide documentation of training regarding false claims to CCL by 10/29/21.
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Based on interviews, the Administrator made a false claim to R1’s authorized representative which poses a potential personal rights risk to persons 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: Kristin Heffernan
LICENSING EVALUATOR NAME: Joann Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4