<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850150
Report Date: 01/02/2024
Date Signed: 01/02/2024 06:28:50 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
12/27/2023 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20231227112658
FACILITY NAME:VARENITA OF WESTLAKEFACILITY NUMBER:
565850150
ADMINISTRATOR:VEJAR, MERIFACILITY TYPE:
740
ADDRESS:95 DUSENBERG DRIVETELEPHONE:
(805) 413-3300
CITY:WESTLAKESTATE: CAZIP CODE:
91362
CAPACITY:90CENSUS: 90DATE:
01/02/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Mark BrassfieldTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff prevented a resident from having visitors.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced visit to investigate the allegation listed above. The LPA arrived at the facility at 11:15 a.m. and met with the Wellness Director (WD) Mark Brassfield and explained the reason for the visit.

On 01/02/2024, at 11:24 a.m., LPA Urena interviewed the Wellness Director, at 11:52 a.m. the LPA interviewed the resident (R1). At 11:50 a.m. the LPA requested records pertinent to the investigation. The LPA interviewed the Reporting Party (RP) at 10:15 a.m.

Continues on LIC 9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024
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-20231227112658
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: VARENITA OF WESTLAKE
FACILITY NUMBER: 565850150
VISIT DATE: 01/02/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
On the allegation that the facility staff prevented a resident from having visitors, it is the concern of the reporting party (RP) that on two separate occasions two of the resident’s visitors (V1) and V2) were not allowed to visit due to a restraining order being in place preventing them from visiting R1. The first visit was approximately on 12/11/2023, and the second visit was on 12/18/2023. Per the RP, the facility staff stated that they could not visit R1 due to a restraining order (RO) preventing V1 from visiting R1. The facility staff were unable to present proof of the RO to the visitors and were told that if they refused to leave, the facility staff would call law enforcement. The interview with the facility's Wellness Director revealed that on 12/12/2023, a person related to R1 left message at the front desk stating that there was a restraining order for V1 and not to allow them to visit R1. However, the WD added that the facility staff did not confirm the validity or existence of the RO, before preventing the visitors to visit R1. Therefore, on 12/18/2023, when V1 and V2 arrived at the facility they were informed that they could not visit R1. R1’s visitors were asked to leave, and per the WD, the V1 and V2 refused to leave, and V1 and V2 became belligerent in the facility’s lobby, consequently law enforcement was called. Law enforcement from the Ventura County Sheriff’s office was called to the facility. Detective Juarez arrived at the facility and verified that there was not a restraining order in place for any visitors for R1. According to the WD, due to the V1’s belligerent behavior, Detective Juarez asked V1 and V2 to leave the premises on 12/18/2023. The LPA interviewed R1 about their desire to receive visitors, specifically V1 and V2. The R1 stated that at this time, they do not wish to be visited by V1, and that they do want to see and be visited by V2. On 01/02/2024, at approximately 12:30 p.m. R1 informed facility staff that they wish to receive visits from V2.

Based on the information received through interviews, the information revealed that the facility did not do their due diligence in confirming that a restraining order was in place, before preventing the visitors from visiting R1. Therefore, the allegation that the facility staff prevented a resident from having visitors, is deemed Substantiated at this time.

Per the California Code of Regulations (CCR), Title 22, see LIC 9099-D for deficiencies cited.

Citations were issued. Exit interview was conducted, signatures obtained. A copy of the report and Appeal Rights were issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20231227112658
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: VARENITA OF WESTLAKE
FACILITY NUMBER: 565850150
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/05/2024
Section Cited
CCR
87468.1
1
2
3
4
5
6
7
87468.1 Personal Rights of Residents in All Facilities.(a) Residents in all RCFE..shall have all of the following
personal rights (11)To have their visitors, including ombudspersons and... permitted to visit privately during reasonable hours and without prior notice...This requirement is not met as evidenced by:
1
2
3
4
5
6
7
POC: Facility Administration staff will review regulation pertaining to visitors, and email the LPA Self-Ceritification by 01/05/2024.
8
9
10
11
12
13
14
Based on interviews review, the licensee did not comply with the section cited above, as one visitors were prevented from visiting R1, which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3