197609623-6-16-2023-29-AS-DPEA-CU4PEY-20230726111552

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609623
Report Date: 06/16/2023
Date Signed: 06/16/2023 01:43:33 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
06/12/2023 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20230612163146

FACILITY NAME:	INN AT THE PARK VENTURA		FACILITY NUMBER:	197609623
ADMINISTRATOR:	ROSE ANGUIANO		FACILITY TYPE:	740
ADDRESS:	21200 VENTURA BLVD		TELEPHONE:	(818) 884-7100
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91364
CAPACITY:	200	CENSUS: 152	DATE:	06/16/2023
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Rose Anguino		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Memory Care is overcapacity.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Martha Arroyo conducted an initial complaint visit for the above allegation. Upon arrival, the LPA met with Administrator, Rose Anguiano and the reason for the visit was explained. Entrance interview conducted.

During today's visit, the LPA walked the facility to ensure there are no health and safety hazards at 10:07 a.m. At 10:11 a.m. the LPA observed the memory care unit on the second floor, conducted interviews with the Administrator and one staff between 9:55 a.m. and 10:31 a.m., and conducted a resident file review and obtained copies of other pertinent documents relevant to the investigation at 10:45 a.m.

Report Continued on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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-20230612163146

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: 197609623
	VISIT DATE: 06/16/2023

NARRATIVE

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Report Continued from LIC 9099...

It was alleged that memory care is overcapacity. It was reported that there were at least thirty (30) residents and not enough beds for them all. During the visit, the LPA conducted a walk-through inside the memory care unit on the second floor. The LPA also observed both residents and bedrooms/beds within the memory care unit. There are twenty-two (22) rooms and thirty-eight beds in total with four (4) of those rooms being single private bedrooms with one (1) bed each. Record review revealed there are currently thirty-five (35) residents in the memory care unit. During the observations, the LPA observed fourteen (14) residents in the activities room with three (3) staff. The facility has the maximum capacity to host thirty-eight (38) residents in memory care. Based on LPA observation and records obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “memory care is overcapacity”. Therefore, the allegation is deemed Unsubstantiated at this time.

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

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

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