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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850221
Report Date: 10/09/2024
Date Signed: 10/09/2024 03:44:51 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
03/13/2024 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20240313134850
FACILITY NAME:GLEN PARK AT OJAIFACILITY NUMBER:
565850221
ADMINISTRATOR:GARY Y LEEFACILITY TYPE:
740
ADDRESS:225 N LOMITA AVETELEPHONE:
(805) 646-2402
CITY:OJAISTATE: CAZIP CODE:
93023
CAPACITY:48CENSUS: 16DATE:
10/09/2024
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Roman Sierra Tovar-EDTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff did not prevent a resident from drinking another resident's drink
Staff did not prevent a resident from running naked while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Esther Cortez conducted a 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 03/14/2024, between 11:30 a.m. and 4:00 p.m., the LPA toured the facility with staff, interviewed the Administrator, two (2) staff, and obtained copies of resident records and other pertinent documents relevant to the investigation. On 08/07/2024, between 11:30 a.m. and 4:30 p.m., the LPA toured the facility with staff, interviewed the Administrator, and obtained copies of resident records and other pertinent documents relevant to the investigation. On 08/08/2024, between 10:55 a.m. and 11:55 a.m., the LPA interviewed two staff and obtained pertinent documents relevant to the investigation. On 10/04/2024, the LPA conducted a file review and one (1) staff and one (1) witness phone interview between 2:00 p.m. and 4:30 p.m.During today's visit the LPA conducted a file review, three (3) staff interviews, one (1) phone interview with Mission Hospice representative between 10:45 a.m. and 3:30 p.m. 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: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
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-20240313134850
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: 10/09/2024
NARRATIVE
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On the allegations that " Staff did not prevent a resident from drinking another resident's drink and Staff did not prevent a resident from running naked while in care,” it is the reporting parties concern that Resident #2 (R2), took and drank Resident #1’s (R1) drink on two occasions, and on the night of 2/21 to 2/22, R2 was running through the facility naked until they could be guided to their room. Staff interviews revealed that R2 does exhibit certain behaviors, such as trying to drink other residents’ drinks and getting out of their room undressed, however all staff interviewed regarding these allegations revealed that they provide support by re-directing R2 and provide care and supervision. Staff stated that they try to intervene as soon as they notice certain behaviors, that the other residents are aware of R2’s behaviors, and they inform new residents as well. They try to prevent it but when R2 takes drinks from other residents, they provide the residents a new drink. Walking around without clothes is not something that is allowed, and if staff sees R2 without clothes they will re-direct them and R2 will go with the staff to get dressed. Staff stated that R2’s behaviors have been discussed by staff and the administrator to address them. Furthermore, assistant Executive Director revealed that R2 has a service coordinator from Tri-Counties Regional Center, and they are currently trying to work with them to get R2 a 1:1 to provide further support for R2. File review revealed that R2 experiences certain challenges, which include fixation on food and challenges with maintaining appropriate social boundaries, however these challenges have been addressed by staff, and R2's service coordinator. R2’s service care plan dated 04/04/2024, revealed that R2 went through medication changes/adjustments the previous quarter that show improvement in their behavior. On the allegations “Staff did not prevent a resident from drinking another resident's drink and Staff did not prevent a resident from running naked while in care.” Information obtained from interviews and file review revealed, R2 does present behavior challenges, however R2’s behaviors have been addressed by Staff and TCRC Service coordinator. Although the allegation may be valid, at this time, there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegations are deemed Unsubstantiated at this time.


Exit interview conducted. Today's report was reviewed and provided to the Executive Director.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3