195850339-4-22-2025-29-AS-KLOZ-DG8T3W-20250430142302

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850339
Report Date: 04/22/2025
Date Signed: 04/22/2025 05:43:54 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
02/04/2025 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20250204095956

FACILITY NAME:	INN AT THE PARK VENTURA		FACILITY NUMBER:	195850339
ADMINISTRATOR:	ANGUIANO, ROSE		FACILITY TYPE:	740
ADDRESS:	21200 VENTURA BLVD		TELEPHONE:	(818) 884-7100
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91364
CAPACITY:	200	CENSUS: 160	DATE:	04/22/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Rose Anguiano		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff allowed resident to leave the facility without proper supervision
Staff did not ensure resident's hygiene care needs are properly met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to deliver investigation finding. Upon arrival LPA met with Administrator Rose Anguiano. The reason for the visit was explained.

On 02/04/2025, Community Care Licensing Division received the above allegations. On 02/05/2025, LPA conducted the initial complaint visit and toured the facility which included random resident rooms, and common areas. Between 10am-11am, during the tour, LPA conducted interview with ten (10) residents and three (3) staff. LPA also requested copies of resident #1’s (R1) records.

Following is a summary of the allegations and investigation finding:
Regarding allegation - Staff allowed resident to leave the facility without proper supervision:
It was reported that staff do not properly supervise R1; R1 continues to leave facility without signing in and out at various times during the night and early mornings. (Continue to LIC9099c.)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025

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-20250204095956

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: INN AT THE PARK VENTURA	FACILITY NUMBER: 195850339
	VISIT DATE: 04/22/2025

NARRATIVE

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It was also reported that R1 is allowed out unsupervised and that R1 panhandles outside the facility. Interviews conducted with staff and R1 revealed that although R1 is non-ambulatory, R1 ambulates with a wheelchair and is able to leave facility unassisted. R1 confirmed that facility does have a book at the front desk for guests and residents to sign in/out. R1 confirmed that leaving the facility without signing out and does not sign in when returned. R1 stated that staff do their rounds and know that R1 is back in the facility therefore R1 does not use the sign in/out book. R1 denied falling while out of the facility. Records reviewed on 4/21/2025, revealed that R1 is able to leave facility unassisted and does not require staff supervision.

Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Staff allowed resident to leave the facility without proper supervision” is deemed unsubstantiated at this time.

Regarding Allegations - Staff did not ensure resident's hygiene care needs are properly met:
It was reported that staff allow R1 to miss scheduled showers and therefore R1 lacks good hygiene. Also, staff do not ensure R1 does not use incontinent briefs routinely. R1 was interviewed and did not recall how often staff provide shower assistance. Facility’s Resident bathing schedule reviewed showed that R1 is scheduled for 2 showers a week. According to staff R1 leaves the facility often and refuses staff assistance with showers. R1 confirmed refusing staff assistance with showering. R1 expressed that when requested staff help; however R1 expressed not needing any help from anyone. Staff interviews revealed that R1 refuses assistance and staff only assist when R1 is willing to accept assistance from staff.

Random residents were interviewed. All residents interviewed reported no issues with showers and other hygiene care service. Residents expressed that staff provide care services as needed. Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Staff did not ensure resident's hygiene care needs are properly met“ is deemed unsubstantiated at this time.

Exit interview held, appeal rights discussed and copy of report provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025

LIC9099 (FAS) - (06/04)

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