197609632-5-11-2023-29-AS-JAPL-CSHL9U-20230605083405

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609632
Report Date: 05/11/2023
Date Signed: 05/11/2023 01:56:50 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
05/08/2023 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20230508162415

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: 124	DATE:	05/11/2023
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Elizabeth Spencer, Executive Director		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff are not replacing or reimbursing residents for lost items.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced 10-day initial complaint visit to this facility. At 9:55 a.m., the LPA met with staff and explained the reason for the visit. At 10:03 a.m., the LPA met with the Executive Director, Elizabeth Spencer.

At 10:05 a.m., the LPA conducted an interview with the Executive Director. At 10:07 a.m., the LPA conducted an interview with Associate Executive Director. Between 10:49 a.m. and 11:27 a.m., the LPA along with the Executive Director and Associate Executive Director, conducted a brief physical plant tour. Between 10:52 a.m. and 11:21 a.m., the LPA also interviewed six (6) out of one hundred twenty-four (124) residents. At 10:27 a.m., the LPA reviewed records and obtained copies of pertinent documents.

Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023

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 3

Control Number 29-AS-20230508162415

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: 05/11/2023

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

Regarding the allegation: Facility staff are not replacing or reimbursing residents for lost items. On 05/08/2023, the Department received a complaint in which it was alleged that the facility does not follow the regulations regarding Theft & Loss. The complainant did not specifically state an incident of the facility not replacing or reimbursing a resident for a lost item. Interview conducted with the Executive Director at 10:05 a.m., explained that the Reserve at Thousand Oak’s Theft and Loss procedures and information is included in both the resident handbook and the admission agreement. The Executive Director explained that prior to admission, the Executive Director holds a meeting with the future resident or resident’s representative to review documents and policies, which includes the Theft and Loss policy. The facilities’ Theft and Loss information and procedures is mentioned three (3) times throughout the resident handbook and admission agreement. The Executive Director provided copies of the handbook and the admission agreement to the LPA. At 10:27 a.m., the LPA reviewed the resident handbook and admission agreement and confirmed that the Theft and Loss policy is in both. The admission agreement has an “Appendix B” that states the California Health & Safety Code sections 1569.152 and 1569.153 and is signed by the resident or the resident representative during the meeting with the Executive Director. The Executive Director also stated that upon admission, the move in documents and paperwork also includes the Client/Resident Personal Property & Valuables (LIC 621).

At 10:07 a.m., the LPA also conducted an interview with the Associate Executive Director. The Associate Executive Director explained that upon admission, it is also communicated with the future resident or resident representative of the option of a safe box for the residents’ personal belongings. The Executive Director explained that if a resident reports a personal belonging missing, the resident reports it to staff and the Executive Director or the Associate Executive Director. From there the Executive Director or Associate Executive Director meet with the resident and fill out the Resident Theft and Loss Record (LIC 9060). Once it’s filled out and if the item is over the value of $100 dollars, they report it to law enforcement. The facility also reports said incidents to Licensing. The Executive Director, and Associate Executive Director or staff also help the resident look for the missing item. The Executive Director explained that the facility does document all efforts in the LIC 9060. Furthermore, the resident handbook states that if a resident has a lost or damaged items that it should be reported to the Front Desk. The admission agreement also states that the facility will be responsible for the loss of any personal property belonging to the resident only if the loss or damage was caused by the negligence of the facility or of the facilities employees.
Continued on LIC 9099-C.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20230508162415

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: 05/11/2023

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

Additionally, interviews conducted with residents did not mention concerns regarding their personal belongings. Per California Health & Safety Code sections 1569.152, if the facility fails to make reasonable efforts to safeguard resident property, then the facility shall reimburse a resident for or replace stolen or lost resident property at its then current value. Based on record review and interviews, the facility does make reasonable efforts to safeguard resident’s property. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated at this time.

Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3