195850339-6-27-2025-29-AS-ZCHN-DJ2SME-20250627135947

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850339
Report Date: 06/13/2025
Date Signed: 06/27/2025 02:00:03 PM

Document Has Been Signed on 06/27/2025 02:00 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
ADMINISTRATOR/ DIRECTOR:	ANGUIANO, ROSE		FACILITY TYPE:	740
ADDRESS:	21200 VENTURA BLVD		TELEPHONE:	(818) 884-7100
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91364
CAPACITY: 200		CENSUS: 155	DATE:	06/13/2025
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:35 PM
MET WITH:	Rose Anguiano		TIME VISIT/ INSPECTION COMPLETED:	01:45 PM

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	Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent case management visit to deliver findings for the above allegation. LPA met with Rose Anguiano and explained the reason for the visit. On 02/06/2025, the Department received a Report of Suspected Dependent Adult/Elder Abuse and an incident report from the facility. The report advised that on 01/13/2025, Resident #1 (R1) reported to the administrator that on 01/10/2025 Staff #1 (S1) inappropriately touched R1’s private area during incontinent care. The Department referred the case to the Community Care Licensing (CCL) Investigations Branch (IB). The case was assigned to Investigator Dennis Seng to conduct the investigation in reference to the allegation. On 02/07/2025, from 10:45am to 1:15pm, Licensing Program Analyst Zabel Chochian conducted an unannounced Case Management - Incident visit at the facility. Upon arrival LPA Chochian met with Administrator Rose Anguiano. The purpose of the visit was to review records and obtain copies of facility records pertaining to a self-reported incident of alleged sexual abuse received by Community Care Licensing (CCL). It was alleged that on 01/10/2025, facility Staff #1 (S1) sexually abused Resident #1 (R1) by inappropriately touching R1’s private area during incontinent care. During the visit LPA conducted an interview with Administrator, reviewed R1 and S1 records and obtained copies of pertinent documents. Administrator was informed that a referral was made to the Community Care Licensing Division (CCLD) Investigations Branch (IB) and assigned to Investigator Dennis Seng for further investigation. (Continue to LIC809c)

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Zabel Chochian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025

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

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 06/13/2025

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On 02/18/2025, from approximately 2:02pm to 3:55pm, Investigator Seng conducted interviews with Administrator, R1, R1’s resident representative, resident, and staff; on 02/19/2025, at approximately 4:06pm, with R1’s roommate; on 04/15/2025, at approximately 1:16pm, with Los Angeles Police Department (LAPD) Topanga Station Detective Brigitta Shapiro; on 04/22/2025, at approximately 3:34pm, with S1; on 04/24/2025, at approximately 4:13pm, with staff; on 05/05/2025, from approximately 12:06pm to 12:43pm, with staff and residents; and on 05/07/2025, at approximately 12:42pm, with Administrator. In addition, Investigator Seng reviewed LAPD Injury Report #25015768 and facility file documents related to the investigation. A review of facility file documents reveals R1 was admitted to the facility on 07/06/2023. R1’s Physician Report, dated 07/01/2023, lists diagnosis of metabolic encephalopathy and nontraumatic subarachnoid hemorrhage. R1 needs assistance with bathing, dressing and toileting; not able to independently transfer to and from bed, non-ambulatory. A review of psychiatric progress notes indicated R1 was seen for routine monthly visits and prescribed medication for major depressive disorder and generalized anxiety disorder. R1’s Appraisal Needs and Service Plan, updated 06/21/2024, documents that “R1 frequently voices wanting to return to Skilled Care. R1 requested a Hoyer lift to transfer and bed rails. Easily becomes upset and anxious, can express rude, mean words to staff. Verbally abusive towards staff, threatening to call Ombudsman and Licensing. Accuses staff of neglect or poor care delivery. Staff reports, R1 can be very disrespectful and will make racist comments”.

Based on file reviews and interviews conducted, there was insufficient evidence to prove that the facility was responsible for Sexual Abuse leading to S1 to have an inappropriate sexual contact with R1 while R1 was at the facility. R1’s roommate, facility staff, and S1 denied any sexual abuse occurring with R1 at any time. R1’s roommate stated that S1 was a good caregiver who never acted inappropriately with any residents. S1 stated that they only went into R1’s room to clean R1 as R1 had fecal matter on R1’s vagina. S1 asked R1 for permission to clean R1’s vagina, and R1 consented. S1 added that the contact with R1 was only for to clean R1 and non-sexual in nature. Based on the evidence and interviews conducted, the allegation of “Sexual Abuse: Resident #1 (R1) was sexually abused by Staff #1 (S1)” is deemed Unsubstantiated at this time. Exit interview, copy of report given.

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Zabel Chochian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025

LIC809 (FAS) - (06/04)

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