197609632-7-27-2023-29-AS-DPEA-CU9VH4-20230731162632

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609632
Report Date: 07/27/2023
Date Signed: 07/27/2023 04:20:23 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
07/24/2023 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20230724105236

FACILITY NAME:	RESERVE AT THOUSAND OAKS, THE		FACILITY NUMBER:	197609632
ADMINISTRATOR:	SPENCER, ELIZABETH		FACILITY TYPE:	740
ADDRESS:	3575 N. MOORPARK ROAD		TELEPHONE:	(805) 492-2471
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	170	CENSUS: 128	DATE:	07/27/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Elizabeth Spencer		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not ensure the safety of food served to residents.
Staff do not maintain food service equipment.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA), Martha Arroyo conducted an initial complaint visit for the above allegations. Upon arrival, the LPA met with Executive Director (ED), Elizabeth Spencer and the reason for the visit was explained. Entrance interview conducted.

During today’s visit, the LPA conducted a physical plant tour to ensure there are no health and safety concerns at 1:10 p.m., a kitchen/food and dining area tour at 1:15 p.m., conducted interviews with the ED, four staff, and nine residents between 1:20 p.m. and 2:19 p.m., and obtained and reviewed documents pertinent to the investigation at 3:00 p.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: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

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-20230724105236

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: RESERVE AT THOUSAND OAKS, THE	FACILITY NUMBER: 197609632
	VISIT DATE: 07/27/2023

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

(Report Continued from LIC 9099...)

It was alleged that staff do not ensure the safety of food served to residents. It was reported that residents are constantly getting sick even after eating the food served. While conducting the walkthrough, the refrigerator, freezer, and pantry were observed to have sufficient food from all different food groups. Food labels were inspected and checked for dates and expiration dates. Food labels had expiration date clearly marked. Interviews conducted with staff revealed food is typically arriving at the facility every other day and food is checked for quality at the same time as it is being received. Interviews conducted with residents revealed they had no concern with the food being served by the facility; and 9 out of 9 residents interviewed reported no issues with the quality of food and denied getting sick due to the food at any time while living at the facility. Based off the information obtained during the investigation, the Department does not have sufficient evidence to support the allegation of “Staff do not ensure the safety of food served to residents.” Therefore, this allegation is deemed Unsubstantiated at this time.

It was also alleged that staff do not maintain food service equipment. It was reported that mold has been previously reported on the food service equipment. While conducting the walkthrough, the coffee, soda, and food service machines were observed and checked for cleanliness. Review of documents revealed the facility had a third-party company come out to the facility in the last 30 days to service the fountain drink machine. Additionally, the service ticket states the third-party company inspected the ice machine and had valve adjusted; however, the service ticket did not report any mold on the machine at the time the service was done. Interviews conducted with kitchen staff revealed the cleaning of the food service machines is done every night. Staff maintain the machines clean everyday and stated they clean the nozzles and certain parts inside on a daily basis to ensure no bacteria grows inside. Based on LPA observation, record review, and interviews, the Department does not have sufficient evidence to support the allegation of “staff do not maintain food service equipment”. Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued at this time. Report was reviewed and a copy was issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2