197607372-8-15-2024-29-AS-KHEN-D8HUMA-20240826154157

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607372
Report Date: 08/15/2024
Date Signed: 08/15/2024 03:06:35 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
05/31/2024 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20240531145527

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: 47	DATE:	08/15/2024
		UNANNOUNCED	TIME BEGAN:	02:52 PM
MET WITH:	Jeannette Ruggiero		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Facility staff handled resident in a rough manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint visit with the purpose of delivering findings for the above listed allegation. Upon arrival, LPA was greeted by front desk staff. LPA met with Administrator Jeannette Ruggiero at 02:52PM and explained the reason for today’s visit. Entrance interview conducted.

During an initial visit conducted on 06/04/2024, LPA interviewed Administrator at 04:10PM, toured the facility at 04:38PM, interviewed Resident #1 (R1) at 04:43PM, conducted interviews with additional management members at 04:59PM, and obtained relevant documents and staff contact information. Throughout the course of the investigation, LPA reviewed documents, additional information provided and conducted interviews. The following was then determined:

Report Continued on LIC 9099-C

Unsubstantiated

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: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

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-20240531145527

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: 08/15/2024

NARRATIVE

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The complaint alleges that facility staff handled resident #1 (R1) in a rough manner based on a statement R1 made indicating Staff #1 (S1) “threw [R1] like a sack of potatoes.” Record review revealed that R1 has a diagnosis of dementia and resides in the facility’s memory care unit. Interview with R1 revealed that S1 is their favorite staff, S1 is very strong and has no trouble lifting R1 by themselves without additional staff assistance. R1 indicated they enjoy S1’s company, as S1 understands R1’s sense of humor and R1 stated that S1 is nice to them. When LPA asked R1 if S1 had ever been rough with them, R1 denied this ever occurring and reiterated that S1 is strong. LPA reviewed the police report taken on the night of the alleged incident. In their interview with police, R1 denied that anyone was rough with them. Additionally, S1 denied the allegation and other staff interviewed indicated they have never witnessed S1, nor any other staff handle any residents in a rough manner. Staff that regularly work with R1 stated that R1 does have a sense of humor and they could see R1 saying that as a joke. No bruising was noted on R1’s body on the night of the alleged incident nor in the days following the alleged incident. Communication with R1’s family revealed that R1 had used this same phrase to describe how a family member had pulled R1 to a seated position. Based on interview and record review, there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that “facility staff handled resident in a rough manner” is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

LIC9099 (FAS) - (06/04)

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