405800577-6-5-2024-29-AS-KBUY-D6F4MR-20240620191358

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405800577
Report Date: 06/05/2024
Date Signed: 06/05/2024 10:16:51 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
03/07/2024 and conducted by Evaluator Erika Miller

COMPLAINT CONTROL NUMBER: 29-AS-20240307135052

FACILITY NAME:	VILLAGE AT SYDNEY CREEK, THE		FACILITY NUMBER:	405800577
ADMINISTRATOR:	KIRK P KLOTTHOR		FACILITY TYPE:	740
ADDRESS:	1234 LAUREL LANE		TELEPHONE:	(805) 543-2350
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93401
CAPACITY:	84	CENSUS: 60	DATE:	06/05/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Liza Hix, Administrator		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff prevent resident from having visitors.
Staff do not allow resident to send mail.
Staff prevent resident from making/receiving confidential phone calls.
Staff do not maintain the facility in clean and sanitary condition.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erika Miller (Miller) conducted an unannounced complaint visit on March 13, 2024. On June 5, 2024, LPA issued final findings on the allegations above. During the investigation, LPA Miller toured the facility and interviewed staff and residents on March 13, 2024, from 10:15 a.m. to 12:40 p.m. LPA also obtained and reviewed relevant documents. LPA met with Liza Hix, administrator, and explained the purpose of the visit.

On the allegation: Staff prevent resident from having visitors. It was alleged that facility staff turned away Resident 1 (R1)’s visitor in January 2024. Administrator stated they never restrict visitors. Administrator stated R1’s family advised that Person 1 (P1), a former caregiver, may try to visit R1 but they have suspicions and asked the facility to keep an eye on P1. On P1’s first visit to the facility, staff overheard P1 say to R1 they will sneak R1 out of the facility. On P1’s second visit, staff observed P1 trying to get R1 to sign checks, which staff reported to the administrator and the family. (Continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Erika Miller	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024

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-20240307135052

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VILLAGE AT SYDNEY CREEK, THE	FACILITY NUMBER: 405800577
	VISIT DATE: 06/05/2024

NARRATIVE

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Staff also overheard P1 ask R1 to tell an attorney P1 can live in R1’s house. Administrator stated visitors including P1 were never turned away, but staff tried to provide supervision to the visits to ensure R1 was safe. Staff confirmed no one was denied visitors, but they did hang around P1’s visits with R1 to ensure R1 was safe. LPA interviewed R1 who stated they don’t get many visitors, as their family lives far away. R1 stated their boyfriend comes to visit and talks to them on the phone. R1 did not indicate that they are not allowed to have visitors, and is not prevented from communicating with their boyfriend. Other residents interviewed stated they have visitors and they are never turned away.

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.

On the allegation: Staff do not allow resident to send mail. Administrator stated residents can mail letters, and they have no reason to not allow residents to send mail. R1 stated no one has brought them stamps or stationary, but they could write a letter and send it to their boyfriend if they wanted to. Other residents interviewed stated they were allowed to send mail. Residents stated they have stamps and have addressed pieces of mail to friends and family. Other residents stated they have given mail to staff and they have mailed it for them with no issues.

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.

On the allegation: Staff prevent resident from making/receiving confidential phone calls. Administrator stated each neighborhood has a phone, and residents are allowed to have cell phones and landlines. Administrator stated R1 does not have a cell phone or landline as the family did not request one. R1 stated they get phone calls from their boyfriend. R1 also stated there is a phone in the facility, but they do not call anyone. Other residents stated they can make and receive phone calls freely and no one prevents them from communicating with their friends and family.

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. (Continued on 9099-C)

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Erika Miller	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20240307135052

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VILLAGE AT SYDNEY CREEK, THE	FACILITY NUMBER: 405800577
	VISIT DATE: 06/05/2024

NARRATIVE

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On the allegation: Staff do not maintain the facility in clean and sanitary condition. It was alleged the facility carpet was dirty in R1’s room. LPA toured the facility on March 13, 2024 and observed the facility was clean. LPA observed all carpet in the facility was clean, including in R1’s room. Residents interviewed stated they liked the facility.

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.

Exit interview conducted, copy of report issued.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Erika Miller	TELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024

LIC9099 (FAS) - (06/04)

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