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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850370
Report Date: 11/14/2023
Date Signed: 11/14/2023 02:06:28 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
11/09/2023 and conducted by Evaluator Elsie Campos
COMPLAINT CONTROL NUMBER: 29-AS-20231109124351
FACILITY NAME:COLONY OF THOUSAND OAKS AT SIDLEE WEST INCFACILITY NUMBER:
565850370
ADMINISTRATOR:AGGARWAL, RASHITAFACILITY TYPE:
740
ADDRESS:171 WEST SIDLEE STREETTELEPHONE:
(805) 496-4541
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:6CENSUS: 5DATE:
11/14/2023
UNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Connie Roush/Rashita AggarwalTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Staff did not offer resident assistance for an extended period of time
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elsie Campos conducted an unannounced initial 10 day complaint visit. The LPA met with staff and Adminstirator Connie Roush and explained the reason for the visit.

During today’s visit, the LPA, conducted a physical plant tour at 12:25 p.m., interviewed residents at 12:55 p.m., 1:03 p.m. and 1:06 p.m., interviewed staff at 1:10 p.m. and 1:15 p.m.

Allegation: Staff did not offer resident assistance for an extended period of time

It was alleged that staff leave Resident #1 (R1) unattended for extended periods of time and do not offer assistance, up to 2 hours. It was alleged that R1 was not checked on as the phone was left online and no one came to hang it up for up to 2 hours. Staff revealed that R1 uses the phone but does not know how to always hang it up and often leaves it online.
**Contunued on LIC 9099-C**
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Elsie Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2023
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 2
Control Number 29-AS-20231109124351
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: COLONY OF THOUSAND OAKS AT SIDLEE WEST INC
FACILITY NUMBER: 565850370
VISIT DATE: 11/14/2023
NARRATIVE
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Staff do not interrupt R1 while they are on the phone and although it is known that R1 does not know how to hang up they will not interrupt to do so and will sometimes wait until the phone starts beeping. Interviews revealed that facility staff were responsible for tending to R1’s care needs both day and night. LPA observed R1 at the time of the visit and R1 did not appear distressed, unwell, or unattended. R1 confirmed that staff check on them throughout the day and it's plenty. R1 did not express any concerns with staff or their attentiveness to care. LPA observed staff doing continuous rounds to check on residents. Interviews with staff and residents confirmed that, staff regularly check in on the residents to ensure that their needs are met. Staff interviews revealed that residents are checked on continuously throughout the day at least every two hours to ensure that the residents needs are met timely. Interviews revealed that staff are responsive in meeting the needs of the residents and did not reveal any concerns regarding staff leaving them unattended for extended periods. Based on the information obtained, there is insufficient evidence to support the claim that staff did not offer resident assistance for an extended period of time. The allegation is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Elsie Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2