567609672-10-28-2024-29-AS-KLOZ-DBD79X-20241125202840

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609672
Report Date: 10/28/2024
Date Signed: 10/28/2024 05:03:47 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
07/26/2023 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20230726084730

FACILITY NAME:	MELOS CARE HOME		FACILITY NUMBER:	567609672
ADMINISTRATOR:	EDWIN PAUL OYASAN		FACILITY TYPE:	740
ADDRESS:	348 W AVENIDA DE LOS ARBOLES		TELEPHONE:	(805) 590-6386
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	6	CENSUS: 5	DATE:	10/28/2024
		UNANNOUNCED	TIME BEGAN:	11:39 AM
MET WITH:	Edwin Paul Oyasan		TIME COMPLETED:	04:07 PM

ALLEGATION(S):

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Staff is utilizing resident's room as storage.
Staff does not ensure resident is provided a bed.
Staff creates a barrier in common room for resident in care.
Staff does not ensure facility is kept clean.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena arrived unannounced for a subsequent complaint visit to deliver the findings for the allegations listed above. The LPA initially met with facility staff; Administrator Edwin Paul Oyasan arrived shortly thereafter. The LPA met with the Administrator and explained the reason for the visit.

On 07/26/2023, Licensing Program Analyst (LPA) Elsie Campos arrived unannounced for an initial complaint visit to investigate the above allegations at 3:20 p.m. The LPA met with Administrator Paul Oyasan and explained the reason for the visit. During today’s visit, the LPA conducted a physical plant tour at 3:25 p.m., interviewed resident at 3:38 p.m., interviewed administrator at 4:03 p.m., and collected pertinent documents at 4:10 p.m.

Continues on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230726084730

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: MELOS CARE HOME	FACILITY NUMBER: 567609672
	VISIT DATE: 10/28/2024

NARRATIVE

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Pg 2.
Staff is utilizing resident's room as storage.
On the allegation that staff is using the residents’ room as storage; it is the concern of the reporting party (RP) that they observed the resident’s (R1) bedroom crowded with various items and used as a storage area. On 07/26/2023, LPA Campos interviewed the Administrator, and residents. LPA Campos conducted a tour of the physical plant areas inside and outside to ensure there are no health and safety hazards. The LPA observed the residents’ rooms to be free of clutter. The residents’ interviews revealed that they were happy with their rooms, and that their rooms were not used for storage. On 10/15/2024, LPA Urena interviewed residents, and residents’ representatives, and the interviews revealed that they were very happy with the way facility staff kept their rooms clean. On 10/11/2024, LPA Urena conducted a tour of the physical plant at approximately 11:01 a.m. and found the facility to be free of clutter and in compliance with Title 22 Regulations. LPA Urena was unable to interview the reporting party.

Although the allegation may have happened or is valid, based on the interviews, and observation, there is insufficient evidence to prove the alleged violation did occur. Therefore, the allegation that staff is utilizing resident's room as storage, is deemed Unsubstantiated at this time.

Staff does not ensure resident is provided a bed.
On the allegation that staff does not ensure resident is provided a bed, it is the concern of the reporting party (RP) that they witnessed a resident sleeping in the living room on two recliners pushed together. 07/26/2023, LPA Campos conducted a physical plant tour, and observed beds in each bedroom for residents living at the facility. On 10/15/2024, LPA Urena conducted a physical plant tour, and observed that residents have a room and a bed designated for their use. Bedrooms one (1), two (2) and three (3) are private rooms; and bedroom four (4) is a shared room. Each bedroom was observed to have a bed(s) and required furniture. On 10/15/2024, LPA Urena interviewed staff, and they stated that sometimes residents do fall asleep on the recliners by the window in the living room area, but that all residents have a bed in their bedroom, and staff will encourage the residents to sleep on their beds. Residents’ representatives’ interviews revealed that they know that sometimes the residents may fall asleep on their recliners, however, they do have a bed in their room. LPA Urena was unable to interview the reporting party.
Based on the information gathered through observation and interviews, the allegation that Staff do not ensure resident is provided a bed, is deemed Unsubstantiated at this time.
Continues on LIC 9099C...

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230726084730

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: MELOS CARE HOME	FACILITY NUMBER: 567609672
	VISIT DATE: 10/28/2024

NARRATIVE

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Pg3. Staff creates a barrier in common room for resident in care.
On the allegation that staff creates a barrier in common room for residents in care; the reporting party (RP) reported that they observed a barrier between the living room area and the common area, creating a barrier for the resident(s) while they are in the living room area and preventing them from going to other areas of the facility. On 07/26/2023, LPA Campos conducted a physical plant tour of the common areas and did not observed barriers of any type. Residents’ interviews revealed that they had not experienced any obstructions within the facility preventing them from moving from the common area to their rooms. LPA Urena interviewed residents’ representatives, and the representatives stated that they had not witnessed barriers preventing residents from moving freely throughout the facility. The Administrator denied staff creating barriers to prevent residents from leaving the common room. The staff denied creating barriers to keep residents secluded in the living room area. LPA Urena was unable to interview the reporting party.

Although the allegation may have happened or is valid, based on the interviews, and observation, there is insufficient evidence to prove the alleged violation did occur. Therefore, the allegation that staff creates a barrier in common room for residents in care, is deemed Unsubstantiated at this time.

Staff does not ensure facility is kept clean.
On the allegation that staff does not ensure facility is kept clean; it is the concern of the reporting party (RP) that the facility was observed to be dirty. On 07/26/2023, LPA Campos interviewed the Administrator, and residents. LPA Campos conducted a tour of the physical plant areas inside and outside to ensure there are no health and safety hazards. The LPA observed the facility to be clean and in order. The residents’ interviews revealed that they were happy with the cleanliness of facility and their room. On 10/15/2024, LPA Urena interviewed residents, and residents’ representatives, and the interviews revealed that they were very happy with the way the facility staff keep their rooms clean. On 10/11/2024, LPA Urena conducted a tour of the physical plant at approximately 11:01 a.m. and found the facility to be clean and in compliance with Title 22 Regulations. LPA Urena was unable to interview the reporting party.

Although the allegation may have happened or is valid, based on the interviews, and observation, there is insufficient evidence to prove the alleged violation did occur. Therefore, the allegation that staff does not ensure facility is kept clean, is deemed Unsubstantiated at this time.
No citations were issued. Exit interview was conducted. A copy of the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2024

LIC9099 (FAS) - (06/04)

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