<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850370
Report Date: 05/30/2024
Date Signed: 05/30/2024 08:46:13 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
04/17/2024 and conducted by Evaluator Zabel Chochian
COMPLAINT CONTROL NUMBER: 29-AS-20240417154252
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: 6DATE:
05/30/2024
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Connie Roush, Assistant AdministratorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff isolates resident.
Staff are not meeting resident overall needs.
Staff do not provide activities for resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to the facility. The purpose of the visit is to deliver investigation findings. Upon arrival LPA met with Connie Roush and explained the reason for the visit. Entrance interview conducted.

On 04/17/2024, Community Care Licensing Division received the above complaint allegations. It was alleged that resident #1 is isolated in this facility moaning and groaning for hours every day with very little social interaction, no physical therapy services and does not get to go outdoors or provided with any activities. It was also mentioned that resident #1 is not provided a higher quality of care as well as a higher quality of living and current medications need to be reviewed by a outside skilled professional and not the facility owner who is a physician or any associate of the facility owner.

Investigation consist of interview with the facility owner, administrator, staff and residents on 04/18/2024; review of resident #1’s records, and interview with potential witnesses on 05/18/204. (Continue to LIC9099c)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024
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-20240417154252
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: 05/30/2024
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
Following is a summary of the allegations and investigation findings:
Regarding allegation “Staff isolates resident” – Information was provided that resident #1 is kept isolated in the facility and does not get to go outdoors. Owner of facility, administrator and staff denied the allegation and stated that when the weather is nice residents are taken out to the backyard and also if resident preferred, they would go out side around the block. According to staff residents are not isolated. Resident #1 was interviewed expressed being satisfied with staff and care. Resident #1 was asked if they feel isolated in the facility and resident expressed being satisfied with the facility staff and care provided. Three out of four residents who were able to communicate with LPA were interviewed and expressed that they feel safe at the facility and are satisfied with the care provided. Residents reported that they are not isolated and have not observed any other resident be isolated in the facility. Potential witnesses interviewed reported that they have never witness any resident to be isolated in the facility. Based on the information obtained during the investigation, the Department does not have sufficient evidence to support the allegation of “Staff isolate resident.” Therefore, this allegation is deemed Unsubstantiated at this time.

Regarding allegation “Staff are not meeting resident needs” – Information was provided that resident #1 is not provided a higher quality of care as well as a higher quality of living. According to reporting party resident #1 was scratching a lot and they are not sure if resident #1 is checked on or evaluated by a skilled professional. Also reporting party expressed that they feel that resident #1’s current medications prescribed are not good for resident #1 and felt that facility needs to have resident #1’s medications reviewed by an outside skilled professional and not the owner of the facility who is a physician or any other physician who is related to the owner. Interview with staff revealed that resident #1 is in no distress and does not require higher level of care and that they are able to meet resident #1’s needs. Owner and Administrator both stated that resident #1’s physician is approved by conservator and friend of resident #1’s. Resident #1 was interviewed and expressed being satisfied with the facility services and likes the facility and staff. Resident #1 did not look distressed or uneasy when observed at the facility during the initial visit on 4/18/2024 and subsequent visit on 05/08/2024. Resident #1’s medication record observed did not reveal any discrepancies and all medications recorded observed prescribed by the physician and reviewed last on 3/21/2024 by Dr. Kirti Talole. Three out of four residents interviewed did not reveal any unmet needs. Potential witnesses interviewed expressed being satisfied with the care services and feel that residents needs are met by care staff.
Based on the information obtained during the investigation, the Department does not have sufficient evidence to support the allegation of “Staff are not meeting resident needs.” Therefore, this allegation is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20240417154252
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: 05/30/2024
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
Regarding allegation “Staff do not provide activities for resident” – Information was received that resident #1 is not offered any activities. Resident #1 was observed resting during LPA’s initial visit on 04/18/2024; LPA spoke with resident #1 once resident woke up. Resident #1 enjoys reading and painting/drawing. Staff and administrator shared some of resident #1’s drawings and stated that resident #1 also likes to read which resident does consistently during the day. Resident #1 acknowledged reading and painting at the facility. Resident expressed receiving great joy in reading and painting. Three out of four residents interviewed expressed that they offered several different activities however some residents choose to participate and other do not. Potential witnesses interviewed stated that facility do provide activities for residents. During the initial and subsequent visit on 04/18/2024 an 05/08/2024, LPA observed resident #1 reading and painting. Other residents were observed watching a movie/show.

Based on the information obtained during the investigation, the Department does not have sufficient evidence to support the allegation of “Staff do not provide activities for resident.” Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of report provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3