565850093-7-8-2025-29-AS-KBUY-DK4SH4-20250731135255

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850093
Report Date: 07/07/2025
Date Signed: 07/08/2025 08:44:32 AM

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
01/14/2025 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20250114102924

FACILITY NAME:	VENTURA VILLA ASSISTED LIVING		FACILITY NUMBER:	565850093
ADMINISTRATOR:	WARD-MICHAYLUK, EVANGELINE		FACILITY TYPE:	740
ADDRESS:	3482 LOMA VISTA ROAD		TELEPHONE:	(805) 644-1292
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	49	CENSUS: 20	DATE:	07/07/2025
		UNANNOUNCED	TIME BEGAN:	09:28 AM
MET WITH:	Dora Islas		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Facility was unable to provide power to residents during power outage
Facility did not designate substitute staff during administrator’s absence
Facility did not have an up-to-date and readily available emergency disaster plan
Staff did not ensure that residents had hot water
Staff are unable to communicate with residents due to language barrier

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted an unannounced subsequent complaint investigation visit. LPA arrived at the facility, met with Medication Technician Dora Islas and explained the reason for the visit. Administrator and House Manager were not at the facility.

On 1/21/2025, LPA conducted an initial complaint investigation visit at the facility. LPA conducted an interview with staff and collected information and documents from the House Manager.

During today’s visit, starting at 10:26 a.m. LPA conducted interviews with four staff and a visitor. LPA also conducted a facility tour at 10:58 a.m.

(continued on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

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

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025

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-20250114102924

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: VENTURA VILLA ASSISTED LIVING	FACILITY NUMBER: 565850093
	VISIT DATE: 07/07/2025

NARRATIVE

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(continued from LIC9099)

Regarding the allegation “Facility was unable to provide power to residents during power outage”: This allegation was regarding a power outage that occurred on 1/13/2025, when Edison conducted a Public Safety Power Shutoff (PSPS) in the area due to fire danger. The power went off at approximately 5:00 a.m. At approximately 7:00 a.m. medication technician Dora Islas (Islas) arrived at the facility. Staff were using flashlights at the time. Most of the residents were still asleep. Islas turned on the generator when she got in. The facility generator powers emergency lighting in the rooms (overhead light), lighting in the hallway, and refrigerators/freezers. The house manager purchased battery operated lanterns for residents’ bathrooms. Natural gas was working in the facility, so they were able to use the stove and oven. The natural gas hot water heaters were also working. There are some areas of the facility where it takes more time for the water to heat up, but it does heat up. Staff also provided extra blankets to residents who needed them. Any residents who usually use additional items to keep warm, such as electric blankets or space heaters, were provided with extra blankets. The power was restored at 10:00 a.m. on 1/14/2025. The visitor who was interviewed did not recall the power outage. Based on interviews, this allegation is deemed unsubstantiated at this time.

Regarding the allegation “Facility did not designate substitute staff during administrator’s absence”: In the hallway near the entry to the facility next to the front desk, the facility has photos up of the care staff and management team. The administrator, assistant administrator and house manager are all displayed on the bulletin board along with the care staff. If nobody from the management team is at the facility, the medication technician will step in to oversee the operation of the facility. The facility has also filed a Designation of Responsibility with Community Care Licensing. Based on interviews and records reviewed, this allegation is deemed unsubstantiated at this time.

Regarding the allegation “Facility did not have an up-to-date and readily available emergency disaster plan”: The facility emergency disaster plan is located in the staff office which all staff have access to. The disaster plan is current and complete. When LPA requested to see the disaster plan, it took one minute for medication technician Dora Islas to locate it. Based on interviews and records reviewed, this allegation is deemed unsubstantiated at this time.

(continued on LIC9099C)

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

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20250114102924

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: VENTURA VILLA ASSISTED LIVING	FACILITY NUMBER: 565850093
	VISIT DATE: 07/07/2025

NARRATIVE

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(continued from LIC9099C)

Regarding the allegation “Staff did not ensure that residents had hot water”: This allegation was specifically regarding the hot water in the room belonging to Resident 1 (R1). According to staff, the facility’s natural gas was still working during the power outage of 1/13/2025 so the facility still had hot water and the ability to cook. R1’s bathroom sink has a small tankless water heater that uses electricity because R1’s representatives complained it took too long for the water in the sink to heat up. During the power outage that small electric water heater did not work. However, the gas water heaters for all facility plumbing were working, it just took a little more time for the water to heat up. Based on the information gathered from interviews, this allegation is deemed unsubstantiated at this time.

Regarding the allegation “Staff are unable to communicate with residents due to language barrier”: The staff interviewed by LPA stated there are some staff working at the facility that do not speak fluent English. Those staff have been instructed on how to use a translation application on their cell phones. In addition, the administrator or house manager make sure there is an English speaking staff scheduled at all times at the facility. The visitor LPA interviewed stated they have problems communicating with certain staff, however they can go to other staff or the administrator if they need to communicate something. Based on these interviews and records reviewed, this allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report provided to the facility.

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

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025

LIC9099 (FAS) - (06/04)

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