197609632-7-26-2023-29-AS-JAPL-CUA3RJ-20230731182849

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609632
Report Date: 07/26/2023
Date Signed: 07/26/2023 04:14:39 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
02/22/2023 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20230222152042

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: 129	DATE:	07/26/2023
		UNANNOUNCED	TIME BEGAN:	03:10 PM
MET WITH:	Elizabeth Spencer		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Staff did not respond to resident's call for assistance in a timely manner
Staff are verbally and psychologically abusing resident
Rate increased without a valid reason

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a subsequent complaint visit. The LPA met with Executive Director Elizabeth Spencer and explained the reason for the visit.

On 1/30/2023, the LPA conducted staff interviews from 9:45 a.m. – 12:00 p.m., and collected pertinent documents. On 7/10/2023, the LPA conducted staff and resident interviews from 10:00 a.m. – 3:15 p.m. Additional resident interviews took place on 07/12/2023 from 10:00 a.m. – 11:15 a.m., and additional staff interviews took place on 7/13/2023 at 11:50 a.m. and 12:12 p.m. On 7/14/2023, the LPA interviewed Resident #1 (R1) at 1:37 p.m., and interviewed three (3) staff at 10:04 a.m., 10:40 a.m., and 11:20 a.m.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

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 7

Control Number 29-AS-20230222152042

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: 07/26/2023

NARRATIVE

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Regarding the allegation: Staff are verbally and psychologically abusing resident.
It was alleged that staff were making inappropriate comments to Resident #1 (R1) in the form of threats, such as telling R1 they will be kicked out, telling R1 not to use the pendant, and berating R1 for requiring assistance. Although staff denied claims that they had been verbally abusive towards R1, some indicated that R1 had been verbally abusive towards them. The LPA obtained a letter issued to R1 from the Executive Director dated 01/23/2023, which noted that R1 was in violation of the Resident Handbook, as it was alleged that R1 used inappropriate language and behavior towards the staff. A review of the Resident Handbook that was signed by R1 indicated that ‘reported incidents of improper behavior, either toward other residents or employees, can result in eviction from the Community’. Per regulation, a licensee may evict a resident for one or more reasons, which can include ‘failure of the resident to comply with general policies of the facility. Said general policies must be in writing, must be for the purpose of making it possible for residents to live together, and must be made part of the admission agreement.’ An interview with R1 revealed that R1 enjoyed residing at the community and denied claims that staff had been rude or disrespectful. R1 admitted that they had had a ‘couple disagreements’ with staff but indicated that everything had been worked out.

In addition, it was alleged that staff had made inappropriate comments towards R1. Staff commented that R1 would use their pendant often to receive care assistance with toileting and repositioning, but R1 had regularly used their pendant for assistance with retrieving their remote, obtaining a tissue, and so on. Staff commented that they would attempt to keep things within reach of R1 as they understand that R1 requires care assistance, but some staff admitted that they had informed R1 that it was best to use the pendant for care assistance or for emergencies only. Staff indicated that they were re-enforcing the use of the pendant to ensure that all residents in the community received prompt and adequate care. Lastly, there was an incident where a staff member was providing care to R1, in which the staff commented that R1 was ‘heavy’. A review of the video footage and interviews indicated that the staff member’s tone was more so matter of fact, and not in an accusatory tone in alluding that they were making an inappropriate comment about R1’s weight or appearance. The video footage further indicated that the staff tried to explain the reason as to why they referred to R1 as heavy by stating that R1 should assist during a one-person transfer, as the staff did not want to get hurt when assisting R1.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 7

Control Number 29-AS-20230222152042

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: 07/26/2023

NARRATIVE

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Based on the investigation, there is insufficient evidence to support the claim that staff are verbally and psychologically abusing resident. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff did not respond to resident's call for assistance in a timely manner
It was alleged that there were instances when R1 waited for over thirty (30) minutes to receive care. Staff indicated that when a resident presses their pendant, a staff member must ‘acknowledge’ the pendant on the facility pager (which is time stamped), but it is not until the staff physically see the resident that they can reset the resident’s pendant, which then indicates that they have ‘responded’ to it. In addition, the staff who acknowledges the pendant isn’t always the staff that responds to the pendant in person. The LPA reviewed R1’s pendant logs from 1/29/2023 – 2/26/2023 and noted that R1 pressed their pendant an average of 16.8 times a day during that time period. The LPA reviewed pendant logs from 06/15/2023 – 07/10/2023 and uncovered that generally, staff respond to resident pendant calls within 4-8 minutes. As it refers to R1’s pendant logs, a review of response times indicated that staff responded to R1’s pendant calls on average within eight (8) minutes. Whereas there were some response times that went between 10-15 minutes, it was not most of the calls and represented sporadic occurrences. Staff claimed that it may take time to respond to a call light if they are assisting another resident with changing, toileting, or a shower. However, staff also noted that they will communicate with other caregivers if they are unable to respond to a resident pendant to ensure that someone is available to reach the resident in a timely fashion. R1 stated in their interview that staff were responsive in meeting their care needs and believed staff responded to their pendant press timely. Based on the information, there is insufficient evidence to support the claim that staff did not respond to resident's call for assistance in a timely manner. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Rate increased without a valid reason
It was alleged that the R1’s monthly rate was increased without a valid reason. Interviews and records review supported claims that on 3/8/2022, R1 experienced a change of condition. As a result, R1’s care level increased from Level 1 to Level 4. There was also further discussion regarding care needs of R1’s dog, as R1’s service plan indicated that staff would walk R1’s dog four times a day.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 7

Control Number 29-AS-20230222152042

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: 07/26/2023

NARRATIVE

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On 4/21/2022, R1’s care plan changed from Level 4 to Level 5. This care plan was signed and dated by R1’s responsible party on 4/21/2022. However, on 4/22/2022, records reflected that R1’s care plan changed back from Level 5 to Level 4. The care plan for 4/22/2022 was not signed by R1’s responsible party until 5/31/2022. Staff noted that this change took place after a care plan meeting with R1’s family. Staff claimed that due to the level of care that R1 required, staff were unable to adjust care services as it related to transfer assistance, toileting, and status checks. However, staff stated that they adjusted the number of times that R1’s dog was walked from four times a day to three times a day. Records from 4/21/2022 displayed the ‘points’ for walking the dog at four times a day at 30 points, yet the 4/22/2022 record then reflected 17 points for walking the dog four times a day. Staff indicated that this was a typing error and brought out invoices to support claims that the dog walking was decreased to 17 points and that R1’s dog was only to be walked three (3) times a day, which brought R1’s care back down to a Level 4. Staff admitted that the document should have been re-issued to R1’s responsible party.

As previously stated, R1 was deemed a Level 5 as of 4/21/2022, and this document was signed by R1’s responsible party. Staff stated they are unable to make a financial change unless there is a signature on a service plan or email confirmation of the change. Even though R1’s care was changed to a Level 4 on 4/22/2022, a signature was not obtained by R1’s responsible party for this document until 5/31/2022. As a result, R1 was charged at the Level 5 rate for the remainder of April 2022 through the end of May 2022. Once the signature was obtained to confirm R1’s care as a Level 4 on 5/31/2022, R1 received the difference in cost between the Level 4 and Level 5 rate in the form of a credit on their account for the time period of 4/22/2022 – 5/31/2022. Lastly, staff and records indicated that R1’s care plan had remained at a Level 4 and had not increased since the beginning of 2023, despite suffering either unwitnessed or assisted falls. Based on the information obtained during the investigation, there is insufficient evidence to support the claim that R1 suffered a rate increase without a valid reason. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 7

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
02/22/2023 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20230222152042

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: 129	DATE:	07/26/2023
		UNANNOUNCED	TIME BEGAN:	03:10 PM
MET WITH:	Elizabeth Spencer		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Resident is not receiving timely medical care

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

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

LIC9099 (FAS) - (06/04)

Page: 5 of 7

Control Number 29-AS-20230222152042

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: 07/26/2023

NARRATIVE

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Regarding the allegation: Resident is not receiving timely medical care

It was alleged that on occasion, R1 did not receive timely medical attention. Records review indicated that on 3/8/2022, R1 complained of chest pain. A review of charting notes for R1 and interviews with R1’s responsible party detailed that R1 was complaining of chest pain. As a result, staff took R1’s vitals and vitals appeared normal. Records indicated that staff called R1’s responsible party and for R1’s responsible party to take R1 to urgent care. R1 also alleged that they had wanted to go to the hospital, yet the facility made the determination to call R1’s responsible party to determine if R1’s responsible party wanted to take R1 to the emergency room. R1’s responsible party demanded that the facility called 9-1-1. Emergency services arrived and R1 was taken to the hospital. Medical records confirmed that R1 required a triple bypass surgery. R1 recovered at a skilled nursing facility and returned to the facility on 4/11/2022. Based on the information obtained in interview and record review, there is sufficient evidence to support the claim that R1 did not receive timely medical care. Rather than call 9-1-1 when R1 complained of chest pain, staff called R1’s responsible party and inquired as to whether they themselves wanted to contact emergency services. This allegation is deemed Substantiated at this time.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-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: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

LIC9099 (FAS) - (06/04)

Page: 6 of 7

Control Number 29-AS-20230222152042

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/26/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/28/2023 Section Cited CCR 87465(g)	1 2 3 4 5 6 7	87465(g) Incidental Medical and Dental Care. (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including ... an apparent life-threatening medical crisis ... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator agreed to do the following: Hold an in-service training with staff, discussing the protocol as it pertains to contacting emergency services. Training must begin by 7/28/2023 and must conclude no later than 8/4/2023.
	8 9 10 11 12 13 14	Based on interview and record review, the licensee did not comply with the section cited above, as staff failed to call 9-1-1 when R1 was experiencing chest pains and instead called R1’s responsible party, which poses an immediate health and safety 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
	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: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

LIC9099 (FAS) - (06/04)

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