197609632-8-23-2022-29-AS-ASMH-CHKPXX-20220823114300

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609632
Report Date: 08/23/2022
Date Signed: 08/23/2022 11:43:46 AM

Document Has Been Signed on 08/23/2022 11:43 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
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:	DATE:	08/23/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Elizabeth Spencer		TIME COMPLETED:	11:50 AM

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Licensing Program Analyst (LPA) Ashley Smith conducted an unannounced Case Management - Incident visit, to conclude the findings from an investigation that began on 5/26/2022. The LPA met with Executive Director Elizabeth Spencer and explained the reason for the visit.

On 5/25/2022, the facility submitted a Report of Suspected Dependent Adult/Elder Abuse and a Special Incident Report, where it was alleged that Resident #1 (R1) had engaged in a sexual relationship with Staff #1 (S1). This incident was referred to the Community Care Licensing Division’s Investigation’s Branch and assigned to Investigator Hector to investigate. Investigator Hector interviewed R1 on 6/7/2022 at 3:30 p.m. and interviewed S1 on 7/22/2022 at 12:28 p.m. Additional staff interviews took place on 6/7/2022 4:50 p.m., and additional resident interviews happened on 7/25/2022 at 1:13 p.m., 1:42 p.m., 1:58 p.m., 2:13 p.m., 2:18 p.m., and 2:38 p.m. A police report regarding the case was requested and reviewed on 6/23/2022.

The investigation revealed that during S1’s tenure at the facility, residents described S1 as hard-working, dedicated, and helpful. Residents whom had consistent interactions with S1 denied claims that they had observed S1 interacting with R1 or other residents inappropriately. Interviews affirmed that S1 engaged with residents in a professional manner. Yet R1 claimed that R1 and S1 had a romantic relationship, in which R1 alleged that they engaged in sexual contact with S1. However, R1 was unable to identify, confirm or deny the presence of tattoos or other modifications on S1’s body, nor was R1 able to recall specific details of their sexual encounters with S1. Per the information obtained from a police report, it was indicated that they were unable to establish that a crime had occurred.

According to interviews with facility residents, R1 was known amongst the residents as being overly affectionate and had been known to kiss residents on the lips in a ‘friendly manner’. Yet S1 denied all claims that they had engaged with R1 in a sexual manner.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 08/23/2022

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Yet, S1 admitted to hugging R1 and to kissing R1 on the forehead. S1 also admitted to engaging in this behavior with another resident at the facility. As many regarded S1 as kind and hardworking, S1 admitted to receiving gratuity gifts from residents ranging from cash, gift cards, and a laptop. S1 also admitted that they knew of the facility policy which prohibited the acceptance of any forms of gratuity from residents. The investigation revealed that as a result of the accusation, S1 was placed on administrative leave. Interviews with S1 revealed that S1 has since resigned. S1 has not returned to the facility.

Whereas there is insufficient evidence to support the allegation of sexual abuse, there is sufficient evidence to support the claim that S1 had inappropriate contact (i.e. hugging and kissing residents on the forehead) with facility residents and accepted gifts from residents.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D):

Exit interview conducted. A copy of the report and appeal rights were issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/23/2022 11:43 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/23/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/30/2022 Section Cited	1 2 3 4 5 6 7	87468.1(a)(1) Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply with the section cited above, as S1 admitted to hugging and kissing R1 on the forehead, as well as accepted gifts from residents, 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

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: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

LIC809 (FAS) - (06/04)

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