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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565800551
Report Date: 08/07/2024
Date Signed: 08/07/2024 12:51:22 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
07/30/2024 and conducted by Evaluator Teresa Camara
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20240730104218
FACILITY NAME:GABLES OF OJAI, THEFACILITY NUMBER:
565800551
ADMINISTRATOR:MATTEO DIGRIGOLIFACILITY TYPE:
740
ADDRESS:701 N. MONTGOMERY ST.TELEPHONE:
(805) 646-1446
CITY:OJAISTATE: CAZIP CODE:
93023
CAPACITY:118CENSUS: 65DATE:
08/07/2024
UNANNOUNCEDTIME BEGAN:
10:33 AM
MET WITH:DeeDee HeningerTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff do not ensure that medication disposal procedures are being followed.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Teresa Camara and Trevor Byrne conducted a complaint investigation visit regarding the above noted allegation. LPAs met with Assisted Living Director (ALD) DeeDee Heninger as the administrator is on vacation. LPAs explained the reason for the visit.

LPAs interviewed staff starting at 10:38 a.m. LPAs reviewed medications to be destroyed starting at 11:10 a.m. LPAs found medications that needed to be destroyed and the Centrally Stored Medication and Destruction Record had been signed by the administrator and ALD that they had already been destroyed when in fact they were still stored in the medication room.

Based on the medication review, the allegation Staff do not ensure that medication disposal procedures are being followed is deemed Substantiated at this time. Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to 9099-D). Exit interview conducted. The report and appeal rights were issued.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
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 3
Control Number 29-AS-20240730104218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GABLES OF OJAI, THE
FACILITY NUMBER: 565800551
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/14/2024
Section Cited
CCR
87465(i)
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87465 Incidental Medical and Dental Care
(i) Prescription medications which are not taken with the resident upon termination of services...or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult wo is not a resident. Both shall sign a
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Licensee will submit a statement of understanding that they reviewed the regulation and confirm medications awaiting destruction have been destroyed.
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record, to be retained for at least three years. Based on record review, the licensee did not comply with the section cited above as there were medications signed off as destroyed but still stored in the med room, 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: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
07/30/2024 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20240730104218

FACILITY NAME:GABLES OF OJAI, THEFACILITY NUMBER:
565800551
ADMINISTRATOR:MATTEO DIGRIGOLIFACILITY TYPE:
740
ADDRESS:701 N. MONTGOMERY ST.TELEPHONE:
(805) 646-1446
CITY:OJAISTATE: CAZIP CODE:
93023
CAPACITY:118CENSUS: 65DATE:
08/07/2024
UNANNOUNCEDTIME BEGAN:
10:33 AM
MET WITH:DeeDee HeningerTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff do not ensure that the facility is maintained in good repair.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Teresa Camara and Trevor Byrne conducted a complaint investigation visit regarding the above noted allegation. LPAs met with Assisted Living Director (ALD) DeeDee Heninger as the administrator is on vacation. LPAs explained the reason for the visit.

LPAs interviewed staff starting at 10:38 a.m. LPAs conducted a tour of the kitchen area where the allegation a sink/drain/disposal was in disrepair. LPAs met with kitchen staff who explained they do not use the garbage disposal. They strain debris and throw it in the trash. For small particles that land in the sink drain they will use the disposal. LPAs met with maintenance director who stated attempts to repair the disposal have been temporarily successful but the facility is ordering a new disposal this week. Based on observations, the facility kitchen was clean and all of the sinks drained properly. Therefore, the allegation Staff do not ensure that the facility is maintained in good repair is deemed Unsubstantiated at this time. Exit interview conducted and the report issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3