565850370-5-30-2024-29-AS-DPEA-D5SSEZ-20240531134934

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850370
Report Date: 05/30/2024
Date Signed: 05/30/2024 08:44:48 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
05/01/2024 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20240501231609

FACILITY NAME:	COLONY OF THOUSAND OAKS AT SIDLEE WEST INC		FACILITY NUMBER:	565850370
ADMINISTRATOR:	AGGARWAL, RASHITA		FACILITY TYPE:	740
ADDRESS:	171 WEST SIDLEE STREET		TELEPHONE:	(805) 496-4541
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	6	CENSUS: 6	DATE:	05/30/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Connie Roush, Assistant Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff stuffed a rag into a resident's mouth while in care.
Staff behavior poses as a risk to the residents.

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 05/01/2024, Community Care Licensing Division received the above complaint allegations. It was alleged that “Staff stuffed a rag into a resident's mouth while in care”. According to reporting party, Resident #1 doesn't speak much, if at all, but makes sounds and one of the staff took a rag and stuffed it into resident #1's mouth to keep resident quiet. It is unknown how often this happens. When reporting party expressed concern for resident #1, it was stated that “this is why everyone keeps leaving” and shared “they are mean to people here”. It was reported that this kind of behavior is inappropriate and poses as a risk to residents.

Investigation consist of interview with the facility owner, administrator, staff, and residents on 05/08/2024;
(continue to LIC 9099c).

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 2

Control Number 29-AS-20240501231609

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

review of resident #1’s records, and interview with potential witnesses on 05/18/204.

Following is a summary of the allegations and investigation findings:

Regarding allegation, “Staff stuffed a rag into a resident's mouth while in care” and “Staff behavior poses as a risk to the residents”. Information was received that staff (name unknown) took a rag and stuffed it into resident #1's mouth to keep resident quiet. It is unknown how often this happens. I was also mentioned that staff are “mean to residents” which is a concern for residents and “this is why everyone keeps leaving”. Staff and licensee/administrator denied the allegation and stated that they are respectful to everyone and would not do such a thing. Staff denied ever being mean to any resident. Three out of the four resident who were able to communicate were interviewed and expressed being satisfied with the staff and care provided. Resident interviewed also denied the allegation and stated that they are not mistreated in any way and feel safe at the facility. Potential witnesses interviewed expressed that staff are good with the residents and they have not witnessed any staff mistreat or act in a mean way towards any of the residents.

Based on the information obtained during the investigation, the Department does not have sufficient evidence to support the allegations of “Staff do not provide activities for resident” and “Staff behavior poses as a risk to the residents”. 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 2