197607372-5-17-2024-29-AS-KHEN-D6N78A-20240627212602

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607372
Report Date: 05/17/2024
Date Signed: 05/17/2024 04:18:38 PM

Substantiated

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
05/15/2024 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20240515160652

FACILITY NAME:	OAKVIEW		FACILITY NUMBER:	197607372
ADMINISTRATOR:	JEANNETTE RUGGIERO		FACILITY TYPE:	740
ADDRESS:	3557 CAMPUS DR.		TELEPHONE:	(805) 241-2000
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	63	CENSUS: 49	DATE:	05/17/2024
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Jeannette Ruggiero		TIME COMPLETED:	04:25 PM

ALLEGATION(S):

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Staff hit resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted an initial complaint inspection at the facility today. LPA arrived at 09:55AM and met with Administrator Jeanette Ruggiero and Assisted Living Director Shaulett Dela Cruz. Entrance interview conducted.

During today's visit, LPA interviewed both facility managers at 10:00AM, toured the facility at 10:30AM, and conducted interviews with residents, staff and other relevant parties from 10:40AM to 02:21PM. Additionally, LPA reviewed the facility's incident report that was submitted to the Regional Office related to the complaint allegation as well as a police report filed. The following was then determined:

It was alleged that Staff #1 (S1) was providing care to Resident #1 (R1) when S1 hit R1 in the back. Incident report reviewed indicated that a witness was entering the room while S1 was providing care and the witness overheard a sound that appeared to be a slap. R1 was then heard saying "please don't hit me."
Report Continued on LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

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-20240515160652

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: OAKVIEW	FACILITY NUMBER: 197607372
	VISIT DATE: 05/17/2024

NARRATIVE

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While S1 initially stated that R1's care that day was typical and without incident, S1 then stated that R1 grabbed S1's hand and squeezed it, causing pain to S1's fingers and that S1 then in turn grabbed R1's hand. Interviews revealed that other staff characterized S1 as "very stubborn" and wants to do things their own way, rather than how the residents prefer their care. Staff indicated there are residents who have reported to them they do not want S1 working with them due to S1 being rough. Staff interviewed indicated R1 is very respectful, gentle and has never shown aggressive behavior. All persons interviewed agreed that the allegation S1 made about R1 grabbing their hand and causing pain to S1's fingers is very uncharacteristic of R1's behavior. Interview with R1 revealed their story aligned with that of the witness, including S1 appearing agitated, the sound of a slap on exposed skin and R1 stating "please don't hit me" following the sound heard. R1 indicated S1 told them they needed to hurry and to stop asking questions. Then S1 hit R1 on the back with an open hand, but stated that it wasn't too hard. Nurse observed R1 and did not note any marks on their back or any part of their body following the incident. Police report reviewed also indicated the same timeline of events, including a hit or slap with an open hand to R1's back. Other residents management interviewed indicated S1 tends to get frustrated, is in a hurry often, and does things their own way. No other residents the LPA interviewed indicated they have witnessed or been subjected to any physical aggression from S1 or any other staff. Management indicated that S1 had previously been counseled regarding their approach with the residents, but that there had been no previous reports of any physical abuse or altercations. S1 was placed on leave as soon as management was made aware of this incident involving R1 and has not returned to the facility since the date of the incident. Management indicated that due to this incident and the previous counseling that S1 had received, S1 will not be returning to employment at the facility. Based on information gathered in interviews and record review, the allegation that "staff hit resident" is deemed SUBSTANTIATED at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D):

Exit interview conducted. Appeal rights were reviewed. A copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240515160652

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: OAKVIEW	FACILITY NUMBER: 197607372
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/17/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/17/2024 Section Cited CCR 87468.1(a)(3)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature... interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator indicated that as of a 03:00PM meeting today, S1 is no longer employed with the facility. As interviews revealed this incident appeared to be isolated to S1 only, no additional staff training is required. POC cleared.
	8 9 10 11 12 13 14	Based on interview and record review, the licensee did not comply with the above cited section, as R1 indicated S1 hit them and S1 admitted to grabbing R1's hand, which poses an immediate personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

LIC9099 (FAS) - (06/04)

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