565801114-3-8-2024-29-AS-KLOZ-D3RVQ2-20240327163735

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801114
Report Date: 03/08/2024
Date Signed: 03/08/2024 03:20:10 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
03/04/2024 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20240304100433

FACILITY NAME:	MANOR OF OJAI, THE		FACILITY NUMBER:	565801114
ADMINISTRATOR:	HALINA GARBACZ		FACILITY TYPE:	740
ADDRESS:	108 W. EUCALYPTUS ST.		TELEPHONE:	(805) 646-1489
CITY:	OJAI	STATE: CA	ZIP CODE:	93023
CAPACITY:	44	CENSUS: 10	DATE:	03/08/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Halina Garbacz		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Licensee yells at residents
Licensee speaks inappropriately to residents
Staff do not ensure that residents' showering needs are met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced initial 10-day complaint visit for the above allegations. Upon arrival, LPA met with Administrator, Helina Garbacz and was explained the reason for the visit. Entrance interview conducted.

During today's inspection, between 10:30 a.m. and 3:00 p.m., the LPA, toured the facility, interviewed the Administrator, two (2) staff, five (5) residents, conducted a file review, and obtained copies of pertinent documents relevant to the investigation.

Regarding the allegations, “Licensee yells at residents” and “Licensee speaks inappropriately to residents” it is the reporting party’s concern that the Licensee yells at the residents and verbally fights with residents. To investigate the complaint the LPA conducted interviews with staff, Home Health Aide, and residents.

Report will continue on LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

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-20240304100433

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: MANOR OF OJAI, THE	FACILITY NUMBER: 565801114
	VISIT DATE: 03/08/2024

NARRATIVE

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Staff and Home Health Aid interviews revealed that they have not heard the Licensee yell at the residents or heard the Licensee spoken to the residents inappropriately. Furthermore, staff stated that if they did, they would report it to licensing, or 911. The Licensee denied ever yelling or speaking inappropriately to the residents. Majority of the resident interviews revealed that they have not been yelled at or spoken inappropriately to. In addition, majority of the resident’s interviews revealed that they have not heard the Licensee yell or speak inappropriately to the other residents. Based on the information gathered, although the allegations may be valid, at this time there is insufficient evidence to support the allegations or that a violation occurred; therefore, the above allegations are deemed UNSUBSTANTIATED at this time.

Regarding the allegation, “Staff do not ensure that residents' showering needs are met” it is the reporting party’s concern that the facility is understaffed, resulting in staff not allowing residents enough time to take their baths. To investigate the complaint the LPA conducted a file review and conducted interviews with staff, Home Health Aide, and residents. File review reveled that three (3) of ten (10) residents receive baths from hospice, and two (2) residents can bathe themselves per their Physicians Report (LIC602), leaving the facility five (5) residents to assist with bathing. Staff interviews revealed that residents are bathe at least two (2) times a week and as needed, however they indicated that there are residents that are on hospice and receive baths from hospice and not from the facility unless needed. Staff interview also revealed that the only reason a resident would go without a shower would be because they refused to shower. Interview with the Home Health Aid revealed that they come two (2) times a week and provide baths for three residents every Tuesday and Friday. Administrator Helena stated that the residents are bathe at least two (2) times a week primarily by the administrator and one other staff (S1) and they keep a record of the weekly baths/showers, however the administrator further stated S1 sometimes forgets to log the showers. The administrator also stated that they have one resident (R1) who refuses to shower. Two (2) of five (5) residents (R1,R2) interviewed revealed that they do not require any assistance with showering and can shower themselves, however per their LIC602 they require minimal or occasional assistance. One (1) of five (5) residents (R3) interviewed revealed that they get assisted with showers every third day. One (1) of five (5) residents (R4) interviewed revealed that they receive a bath two times a week ever since they been admitted to the facility. The LPA observed all residents clean during todays visit. Based on the information gathered, although the allegations may be valid, at this time there is insufficient evidence to support the allegations or that a violation occurred; therefore, the above allegation is deemed UNSUBSTANTIATED at this time.

Exit interview and report review was conducted with Administrator. A copy of the report was given,

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC9099 (FAS) - (06/04)

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