565850221-9-1-2022-29-AS-KHEN-CJBW4U-20220916165807

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850221
Report Date: 09/01/2022
Date Signed: 09/01/2022 04:23:58 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
06/06/2022 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20220606084029

FACILITY NAME:	GLEN PARK AT OJAI		FACILITY NUMBER:	565850221
ADMINISTRATOR:	PINK, TILLMAN JR.		FACILITY TYPE:	740
ADDRESS:	225 N LOMITA AVE		TELEPHONE:	(805) 646-2402
CITY:	OJAI	STATE: CA	ZIP CODE:	93023
CAPACITY:	48	CENSUS: 16	DATE:	09/01/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Rafael Silva		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Call button is not within reach for residents.
Staff did not keep resident’s room free from odor.
Staff did not ensure resident is provided an adequate amount of water.
Staff left resident in soiled clothing for an extended period of time.
Staff not assisting residents during meal time.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced subsequent complaint inspection regarding the above allegations. The LPA met with interim Administrator Rafael Silva at 11:05 AM and explained the reason for today's inspection.

During the previous inspection on 06/14/2022, the LPA conducted a physical plant tour with Administrator at the time, Nicole Zanders, at 2:44 PM and interviewed one resident at 2:59 PM. Interviews were conducted with Zanders during the inspection.

During today's inspection, the LPA conducted a physical plant tour of the facility with the Administrator, conducted three resident interviews and five staff interviews between 11:20 AM and 1:10 PM, and reviewed facility records beginning at 1:30 PM.

Report continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

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-20220606084029

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: GLEN PARK AT OJAI	FACILITY NUMBER: 565850221
	VISIT DATE: 09/01/2022

NARRATIVE

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The allegation of 'Call button is not within reach for residents' alleges the call buttons for assistance are not within a reachable distance for residents. During the previous physical plant tour on 06/14/2022 and during today's inspection, the LPA observed the call buttons and pull cords to be at the head of the resident beds. Interviews conducted with residents revealed no issues or concerns regarding the placement of the call buttons. Interviews with staff revealed no complaints received by residents regarding the placement and accessibility of the call buttons. Based interviews and observation, there is insufficient evidence to support the allegation. Therefore, the allegation of 'Call button is not within reach for residents' is unsubstantiated at this time.

The allegation of 'Staff did not keep resident’s room free from odor' alleges resident rooms smells of urine and housekeeping is not cleaning residents rooms. During the previous inspection on 06/14/2022 and during today's inspection, the LPA toured all the resident bedrooms. The resident rooms were clean and odor free during the inspections. Interviews with residents and staff revealed no issues or concerns regarding odors or cleanliness of the resident rooms. Based on interviews and observation, there is insufficient evidence to support the allegation. Therefore, the allegation of 'Staff did not keep resident’s room free from odor' is deemed unsubstantiated at this time.

The allegation of 'Staff did not ensure resident is provided an adequate amount of water' alleges no water is being provided to the residents and some residents do not have pitchers in their room. During today's visit, water pitchers were observed in three resident rooms and the pitchers for two resident rooms were currently being washed. Today, the LPA also observed some residents in the living room with water cups. During both visits, a water station with cups was observed in the dining room. Interviews with residents revealed they are offered water daily. Interviews with staff revealed water is offered multiple times a day and the residents who are able to pour their own water have pitchers in their room. Based on interviews and observation, there is insufficient evidence to support the allegation. Therefore, the allegation of 'Staff did not ensure resident is provided an adequate amount of water' is unsubstantiated at this time.

The allegation of 'Staff left resident in soiled clothing for an extended period of time' alleged when Staff #1 (S1) worked the overnight shift, residents were observed soiled in the morning, including Resident #1 (R1). Interviews with R1 revealed staff change R1 once or twice at night and they had no issues or concerns with being left in soiled clothing. Interview with S1 revealed all residents are checked and changed when needed during the night shift. Report continued on LIC 9099-C.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220606084029

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: GLEN PARK AT OJAI	FACILITY NUMBER: 565850221
	VISIT DATE: 09/01/2022

NARRATIVE

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Interviews with staff and residents revealed no issues or concerns with residents not being changed during the overnight shift. Based on the information obtained, there is insufficient evidence to support the allegation. Therefore, the allegation of 'Staff left resident in soiled clothing for an extended period of time' is unsubstantiated at this time.

The allegation of 'Staff not assisting residents during meal time' alleges residents are not being provided their special diets of chopped or pureed food and one resident is not being provided additional food or water when requested. During today's inspection, the LPA observed lunch being served. Three residents were identified as needing a puree diet and one resident was identified as needing a chopped diet. The pureed food was being prepared when the LPA arrived and a chopped diet was observed to be served to one resident. The three resident who are currently receiving a puree diet are non-verbal. Interviews with staff revealed residents are always served their special diets and are assisted with eating. The name provided for the resident who is not receiving additional food and water when requested is not the name of any current or recent residents. Interviews with staff revealed some residents request additional food or water and it is always provided. If the resident is on a special diet, the resident may be counseled on whether they should be eating these additional items but the items are always provided. Interviews with residents revealed additional food or water is provided when requested. Based on the information obtained, there is insufficient evidence to support the allegation. Therefore, the allegation of 'Staff not assisting residents during meal time' is unsubstantiated at this time.

Exit interview and report reviewed with Interim Administrator Rafael Silva. A copy of the report and appeal rights will be emailed.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

LIC9099 (FAS) - (06/04)

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