565801019-7-15-2025-29-AS-KBUY-DK4TP9-20250731145358

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801019
Report Date: 07/14/2025
Date Signed: 07/15/2025 02:41:17 PM

Unsubstantiated

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
05/20/2025 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20250520150238

FACILITY NAME:	MOUNTAIN VISTA OF OJAI		FACILITY NUMBER:	565801019
ADMINISTRATOR:	NICKIE PEREZ		FACILITY TYPE:	740
ADDRESS:	602 EAST OAK STREET		TELEPHONE:	(805) 646-6850
CITY:	OJAI	STATE: CA	ZIP CODE:	93023
CAPACITY:	38	CENSUS: 28	DATE:	07/14/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Nickie Perez		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Facility staff did not provide resident medication as prescribed.
Facility staff handles residents in a rough manner.
Facility staff do not ensure resident's hygiene needs are being met.
Facility staff are not assisting with soiled diapering in a timely manner.
Facility staff are not communicating with the residents’ hospice agency/representative.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit regarding the above allegations. LPA met with Administrator Nickie Perez and back-up Administrator Teresa Burdick and explained the reason for the visit.

On 5/21/2025, LPA Erica Mosley conducted the initial complaint investigation visit. LPA Mosley conducted interviews with the licensee, administrator, staff, and witness, as well as collected pertinent documents.

On 7/11/2025, LPA Camara attempted interviews with four witnesses via telephone. Two witnesses stated they had no information regarding these allegations. Messages were left for two other witnesses; however, they did not respond. During today’s visit 7/14/2025, starting at 9:50 a.m. LPA conducted interviews with the administrators and three witnesses. LPA conducted a review of medications for Resident 1 (R1) at 12:38 p.m.

(continued on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20250520150238

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: MOUNTAIN VISTA OF OJAI	FACILITY NUMBER: 565801019
	VISIT DATE: 07/14/2025

NARRATIVE

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(continued from LIC9099)

Regarding the allegation “Facility staff did not provide resident medication as prescribed”: LPA reviewed medication records; it appeared medications were given to R1 as prescribed. The complaint alleged PRN medications were not given. LPA observed PRN medication was given as requested by hospice nurses. Staff stated on or about 5/15/2025, R1 was unable to self administer medications due to being so sedated from prior doses. The hospice nurse wanted R1 to receive another dose of a sedating medication but R1 was already too sedated and could not self administer. The hospice nurse somehow administered the new medication order. Based on interviews and records reviewed this allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Facility staff handles residents in a rough manner”: LPAs interviewed staff and witnesses regarding this allegation. There were no witnesses to any residents being handled in a rough manner. Based on interviews this allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegations “Facility staff do not ensure resident's hygiene needs are being met” and “Facility staff are not assisting with soiled diapering in a timely manner:” LPAs interviewed staff and witnesses regarding these allegations. Bathing is provided on a schedule or more often as needed. Residents on hospice are bathed by hospice personnel on a schedule and hygiene is provided as needed by facility staff. Residents’ incontinence care needs are checked every one to two hours or more often as needed. Witnesses who were interviewed stated they did not have any concerns about hygiene and incontinence care provided by the facility staff. Based on interviews these allegations are deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Facility staff are not communicating with the residents’ hospice agency representative”: LPA’s interviewed staff and witnesses and reviewed documents. Based on documentation received by CCL, whenever there is a reportable incident involving residents at the facility who are on hospice, the hospice agency is also notified. Based on interviews with staff and witnesses, the facility communicates with hospice and family members when a resident on hospice has any issues that must be addressed. Based on interviews and records reviewed, this allegation is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted and report issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025

LIC9099 (FAS) - (06/04)

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