565850221-10-4-2024-29-AS-KLOZ-DAGVH8-20241028162642

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850221
Report Date: 10/04/2024
Date Signed: 10/04/2024 04:54:21 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: 16	DATE:	10/04/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Roman Sierra Tobar		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Residents left soiled for an extended amount of time.
Residents are not awarded privacy.
Staff did not provide adequate supervision.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced subsequent complaint visit for the above allegations. 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. During the week of 5/20/2024, LPA Cortez interviewed R2's Tri-Counties Regional Center (TCRC) Service Coordinator via email correspondence. 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. Report will continue on LIC9099-C 2nd page.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024

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: 10/04/2024

NARRATIVE

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On 10/01/2024, the LPA toured the facility and observed all residents starting at 3:50 p.m., interviewed five (5) residents and two (2) staff. During today's visit, the LPA conducted a file review, and interviewed two (2) staff.

On the allegation "Residents left soiled for an extended amount of time."; it is the concern of the reporting party that two staff often leave residents in soiled clothing sometimes for up to 30 minutes. It was further reported that a third staff, Staff #1 (S1), has told residents to just use the restroom by themselves. To investigate the allegation the LPA conducted a file review, staff and resident interviews, and observations. File review revealed that the facility did not have staff by the names that the RP provided for the two staff that allegedly leave residents soiled for up to 30 minutes, however does have staff with similar names. Staff interviews revealed they have not observed any residents left soiled for a long period of time, and when a resident are soiled staff immediate assist the resident with incontinence care and clothing change if needed. S1 denied the allegation and stated that they call a caregiver over their walkie-talkie to change the residents if they notice a resident needs to changed and they ensure it gets done. S1 further stated that they are not a caregiver and do not have current proper training in changing residents, therefore they get a care giver or MedTech to assist the residents. Residents interviewed stated they were not left soiled for an extended amount of time, and that staff help when needed. On 08/07/2024, at 1:10 p.m. the LPA observed a resident coming out of their room with soiled pants, as soon as S1 saw them, they called for a caregiver to assist the resident get changed. The LPA observed a caregiver acknowledge the request from S1 and headed towards the resident. After a few minutes the LPA observed the resident with clean pair of pants on. The LPA did not observe any evidence of the allegation while at the facility. Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, it is deemed Unsubstantiated at this time.

On the allegation " Residents are not awarded privacy"; it is the concern of the reporting party that residents are being changed with their room doors open and other residents are walking by looking at them. To investigate the allegation the LPA conducted interviews and observations. Staff interviews revealed that residents are changed in their rooms, or the bathrooms and the doors are always being closed to award the resident’s privacy. Staff revealed that they have not observed the doors being left opened. Residents revealed that staff always close the doors when changing them. On 08/07/2024 at approximately 1:08 p.m. the LPA observed a caregiver assist a resident to the restroom and closed the door awarding privacy to the resident. Report will continue on LIC9099-C 3rd page.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024

LIC9099 (FAS) - (06/04)

Page: 2 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: 10/04/2024

NARRATIVE

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The LPA did not observe any evidence of the allegation while at the facility. Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, it is deemed Unsubstantiated at this time

On the allegation " Staff did not provide adequate supervision"; it is the concern of the reporting party that Resident #2 (R2) had fallen out of the recliner in the television room, three (3) times (unknown if any injuries) because there were no staff checking on the residents. No dates were provided for the falls. To investigate the allegation the LPA conducted file review and interviews. A review of the Unusual Injury/Incident reports, dated 01/20/2023, and 03/16/2023 documented that on 01/20/2023 and on 03/15/2023, R2 obtained falls, however during both falls there were care givers present and they were in R2’s bedroom or shower. No other falls were reported to CCL regarding R2 obtaining falls from the facility prior to the complaint received in April of 2023. A review of R2’s admission agreement, dated 11/12/2021, revealed that R2 was not under one-to-one supervision program that is offered as optional items and services for and added rate. Staff interviews revealed that residents are supervised regularly by a caregiver, and that R2 did not require 24-hour supervision, however they would closely monitor R2 due to their seizure disorder. Caregivers make their rounds supervising residents and ensuring the safety of the residents. However, it is standard that residents may be left alone for short periods of time while caregivers are assisting other residents. Staff also reveal that there are always two care givers, one MedTech, and front office staff providing supervision to residents in care. In addition, there is cameras in the common areas including the television room to provide an added source of supervision for staff who is at the front office and are able to look at the cameras. R2’s service coordinator interview revealed that they are not aware of any issues or concerns by or about any of the residents, and that R2’s needs were met. During all the LPA’s visits throughout the investigation, the LPA observed staff making rounds and assisting residents when needed. Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, it 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: 10/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024

LIC9099 (FAS) - (06/04)

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