565801637-1-27-2023-29-AS-KBUY-CNKTE4-20230130133918

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801637
Report Date: 01/27/2023
Date Signed: 01/27/2023 01:05:40 PM

Unsubstantiated

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
08/30/2021 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20210830085056

FACILITY NAME:	VETERANS HOME OF CALIFORNIA-VENTURA		FACILITY NUMBER:	565801637
ADMINISTRATOR:	JULIAN BOND		FACILITY TYPE:	740
ADDRESS:	10900 TELEPHONE ROAD		TELEPHONE:	(805) 659-7515
CITY:	VENTURA	STATE: CA	ZIP CODE:	93004
CAPACITY:	60	CENSUS: 57	DATE:	01/27/2023
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Julian Bond		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Resident sustained pressure injury while care
Staff failed to meet residents incontinent care needs
Staff forced resident to sign documents without residents authorized representative authorization

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted a subsequent complaint visit to deliver findings for the above allegations that were investigated by LPA JoAnn Rosales. LPA met with Administrator Julian Bond and explained the reason for the inspection.

Concerns were that resident #1 (R1) sustained a pressure injury while in care as staff would not let R1 get up from bed and would have to sit in a wheelchair all day. On 9/8/21 starting at 12:55 pm interviews were conducted with staff and R1. R1 when interviewed denied that staff was not letting them get out of bed. R1 stated that when they moved into the facility they could move themselves. R1 stated that staff would check on them every hour and would reposition them every 2 to 4 hours. Staff when interviewed denied telling R1 that they could not get out of bed and R1 was able to reposition themselves.

Report continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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-20210830085056

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: VETERANS HOME OF CALIFORNIA-VENTURA	FACILITY NUMBER: 565801637
	VISIT DATE: 01/27/2023

NARRATIVE

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A review of R1’s records on 12/22/22 starting at 4:13 pm revealed that R1’s pressure injury was being treated by a Hospice agency. Based on the information obtained during the investigation, the allegation that resident #1 (R1) sustained a pressure injury while in care is unsubstantiated at this time.

Concerns were that staff failed to meet resident #1 (R1)’s incontinent care needs as staff were putting 3 diapers on R1 so they would not have to change R1. On 9/8/21 starting at 12:55 pm interviews were conducted with staff and R1. R1 when interviewed denied that staff were putting 3 diapers on them at one time. R1 stated that staff are really good about helping them. R1 stated that the staff are very attentive. Staff when interviewed denied ever putting 3 diapers on R1. Based on the information obtained during the investigation, the allegation that staff failed to meet resident #1 (R1)’s incontinent care needs is unsubstantiated at this time.

Concerns were that staff forced resident #1 (R1) to sign documents without residents authorized representative authorization.

On 9/8/21 starting at 12:55 pm interviews were conducted with staff and R1. R1 when interviewed denied that staff forced them to sign documents without their authorized representative authorization. Staff when interviewed denied forcing R1 to sign documents without their authorized representative authorization. Based on the information obtained during the investigation, the allegation that staff forced resident #1 (R1) to sign documents without residents authorized representative authorization is unsubstantiated at this time.

Exit interview conducted. Today's report and appeals rights were reviewed and a copy was provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC9099 (FAS) - (06/04)

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