197609518-10-10-2024-29-AS-DPEA-DAAQ44-20241022114944

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609518
Report Date: 10/09/2024
Date Signed: 10/10/2024 02:47:14 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
02/01/2024 and conducted by Evaluator Valeria Conway

COMPLAINT CONTROL NUMBER: 29-AS-20240201230214

FACILITY NAME:	BELMONT VILLAGE CALABASAS		FACILITY NUMBER:	197609518
ADMINISTRATOR:	NELSON, NANCY		FACILITY TYPE:	740
ADDRESS:	24141 VENTURA BLVD		TELEPHONE:	(818) 222-2600
CITY:	CALABASAS	STATE: CA	ZIP CODE:	91302
CAPACITY:	165	CENSUS: 132	DATE:	10/09/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Diana Alvarado		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are forcing residents into the shower while in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Valeria Conway made a subsequent complaint visit to facility to deliver complaint findings. Administrator was unavailable during today's visit, but authorized Diana Alvarado, Director of Resident Care Services to sign today's reports. LPA explained the purpose of the visit.
Entrance interview conducted.

It was alleged that staff are forcing residents into the shower. It was further reported that staff are forced residents into the shower even if the resident screams or refuses.

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria Conway	TELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

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

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 29-AS-20240201230214

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: BELMONT VILLAGE CALABASAS	FACILITY NUMBER: 197609518
	VISIT DATE: 10/09/2024

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
26
27
28
29
30
31
32

Continued from LIC 9099

On 02/08/2024, LPAs V. Conway and K. Dulek conducted an initial 10-day visit. During the visit, LPAs conducted a tour of the physical plant at 10:15 A.M. LPAs also conducted interviews with Administrator, staff, and several residents between 10:15 A.M. to 11:20 P.M and obtained pertinent documents relevant to the investigation.

On 08/28/2024, LPA V. Conway interviewed a random number of residents and staff. Additionally, LPA attempted to contact the Reporting Party (RP) on 02/06/2024, 02/07/24 and on 08/24/2024, however, was not successful.

Information gathered during the course of the investigation reflected staff do not force residents into taking showers. If a resident does not want to shower, staff will try to verbally convince them by explaining how beneficial it is to get their bodies clean. Additionally, staff stated that they are aware of the residents’ personal right to refuse and if the resident does refuse, staff will notate the refusal on the daily staff notes and then inform Med-Techs/Director of Nursing. The Director of Nursing will then in return notify the residents responsible party and the primary care physician (PCP).

Interviews with residents revealed that they are well taken care of and had no concerns. Furthermore, residents stated that no staff try to make them do things against their will. Record review of the facility shower schedule consisted of a schedule for each resident and a bath/shower monitoring form that staff use to document when a resident refuses a shower or bath.

Based on the information gathered during the course of the investigation, the Department does not have sufficient evidence to support the allegation, therefore the allegation "Staff are forcing residents into the shower while in care" is deemed UNSUBSTANTIATED at this time.

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

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria Conway	TELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2