565850221-10-1-2024-29-AS-KLOZ-DAGVH9-20241028162643

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850221
Report Date: 10/01/2024
Date Signed: 10/01/2024 05:24:45 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
04/03/2023 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20230403161332

FACILITY NAME:	GLEN PARK AT OJAI		FACILITY NUMBER:	565850221
ADMINISTRATOR:	GARY Y LEE		FACILITY TYPE:	740
ADDRESS:	225 N LOMITA AVE		TELEPHONE:	(805) 646-2402
CITY:	OJAI	STATE: CA	ZIP CODE:	93023
CAPACITY:	48	CENSUS: 15	DATE:	10/01/2024
		UNANNOUNCED	TIME BEGAN:	03:48 PM
MET WITH:	Roman Sierra Tovar-ED		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility not providing adequate food service.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced subsequent complaint visit for the above allegation. Upon arrival, LPA met with Executive Director Roman Sierra Tobar and was explained the reason for the visit.

On 4/10/2023 LPAs Cortez and Kelly Dulek along with facility ED toured the facility at 10:15AM, interviewed staff at the following times: 12:29PM, 01:14PM, 01:55PM, 02:42PM, 04:25PM, and 05:22PM, interviewed Administrator throughout the visit, and reviewed records at 04:15PM. On 08/01/2023, LPA Cortez toured the facility from 9:40 a.m. - 9:50 a.m., reviewed documents with the ED and Assistant adminisrtator at 10:12 a.m. and interviewed residents at 11:14 a.m., 11:32 a.m., 11:40 a.m., 11:44 a.m. and staff at 2:32 p.m. On 08/07/2024, between 11:30 a.m. and 4:30 p.m., the LPA toured the facility with the ED, and obtained copies of pertinent documents relevant to the investigation. During today's visit the LPA toured the facility and observed all residents starting at 3:50 p.m., interviewed five (5) residents and two (2) staff. Report will continue on LIC9099-C 2n page.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024

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-20230403161332

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: GLEN PARK AT OJAI	FACILITY NUMBER: 565850221
	VISIT DATE: 10/01/2024

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 is not providing adequate food service; it is the concern of the reporting party that Residents are being provided dinner at 3:30 PM and also being provided the same meal that they had for lunch. To investigate the allegation a file review and observations were conducted, and staff and residents were interviewed. On 08/07/2024, the LPA observed lunch time approximately at 12:00 p.m. and did not observe lunch take place at 3:30 p.m. File review revealed that the communities Plan of Operation indicates that Breakfast is at 6:30 a.m. and dinner at 5:30 p.m. during the week and on weekends breakfast is at 8:00 a.m. and dinner is at 6:00 p.m. Majority of the Staff that were asked regarding the meal scheduled revealed that breakfast is at 7:00 a.m. and dinner is at 4:00 p.m., with some stating that dinner is at 5:00 p.m. Five (5) out of five (5) Residents interviewed regarding the allegation revealed that they like the food that is served at the facility. File review and staff interviews revealed that food is prepared based on the menu. During today’s visit the LPA observed staff getting residents ready and assisting them to the dining room for dinner starting at 4:30 p.m. to be served dinner at 5:00 p.m. The LPA also observed left over food from lunch in the kitchen that consisted of fish and a broccoli soup at 4:00 p.m. and observed BBQ chicken, vegetables, and bread being served for dinner at 5:00 p.m. One resident interviewed today confirmed that they ate fish, noodles with a cream on top and a salad for lunch and that they do not get served the same meals for lunch and dinner. The LPA observed one (1) out of the fifteen (15) residents eating noodles with cream at dinner, and staff revealed that they had offered the BBQ chicken meal and the resident did not want to eat it, and they offered a meal that they know they like and will eat. Based on the information gathered during the investigation, there is insufficient evidence to support the claim that Facility not providing adequate food service;. Therefore, this allegation is deemed Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3