421700411-8-10-2023-29-AS-KBUY-CV7K7X-20230830073953

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 421700411
Report Date: 08/10/2023
Date Signed: 08/10/2023 12:59:54 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 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
09/22/2022 and conducted by Evaluator Brian Phillips

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20220922112716

FACILITY NAME:	VALLE VERDE		FACILITY NUMBER:	421700411
ADMINISTRATOR:	SUSAN E PONCE		FACILITY TYPE:	741
ADDRESS:	900 CALLE DE LOS AMIGOS		TELEPHONE:	(805) 883-4193
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93105
CAPACITY:	547	CENSUS: 369	DATE:	08/10/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jeremiah Hovsepian Bearce, Director of Health Services and Christina Burton, Infection Preventionist (RN)		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff do not provide proper medication assistance to residents in care
Staff do not attend to residents in a timely manner
Staff do not properly maintain resident's prescription medication records

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Phillips conducted an unannounced subsequent complaint visit to issue final findings on the allegations above. LPA met with Christina Burton, Infection Preventionist, as well as Jeremiah Hovsepian Bearce, Director of Health Services, and explained the purpose of the visit.

On the allegation: Staff do not provide medication assistance to residents in care. It is alleged that Staff members have given wrong medications to residents in care. The allegation states four incidents have occurred between 9/6/22 through 9/22/22 in which multiple residents in different rooms were given incorrect medications.

On 09/27/2022, LPA interviewed staff members and residents in the facility. No staff member nor resident confirmed the allegation. Staff interviewed stated they had not observed any resident being given incorrect medications. LPA did not observe any evidence of the allegation while at the facility. Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian Phillips	TELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

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-20220922112716

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: VALLE VERDE	FACILITY NUMBER: 421700411
	VISIT DATE: 08/10/2023

NARRATIVE

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On 09/27/2022, LPA received documentation of daily medications given to residents, as well as the Centrally Stored Medication & Destruction Record. On 05/12/2023, separate LPA conducted record review of the records/documentation of medication for residents and the Centrally Stored Medication and Destruction Record received by separate LPA from the facility on 09/27/2022. No errors or questionable staff marking were found in any of the resident medication documentation. LPA saw no incidents between 09/06/2022 through 09/22/2022 in which wrong medications had been documented being given to any resident. While investigating a separate complaint at the facility on 05/12/2023, LPA interviewed residents who stated that they had never been given any wrong medication at the facility or heard or any other resident receiving any incorrect medication.

Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, it is deemed Unsubstantiated at this time.

On the allegation: Staff do not attend to residents in a timely manner. It is alleged that Staffing at the facility is in a constant state of flux, and that staff members do not respond to radio calls, so residents are left unattended for long periods of time. The allegation does not know the exact amount of time the residents are left unattended for, but that it was a constant issue.

On 09/27/2022, LPA observed the Staff of the facility while at the facility for the complaint investigation visit. The LPA observed all staff members answering radio calls and attending to residents on a consistent basis. While investigating a separate complaint at the facility on 05/12/2023, separate LPA interviewed witnesses who indicated that staff members are attentive to the needs of residents in a timely manner at the facility. LPA did not observe any received radio call by facility staff members go unanswered or ignored. On 08/10/2023, LPA observed staff members answering radio calls in a timely manner and assisting residents when/if needed. LPA did not observe any staff refusing or neglecting to answer a radio call at the facility.

Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, it is deemed Unsubstantiated at this time.

On the allegation: Staff do not properly maintain resident’s prescription medication records. It is alleged that there are documentation errors on narcotic medication including multiple bottles with various amounts of medication and incorrect pill counts. The allegation does not know if there is any medication missing.

Continued on 9099-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian Phillips	TELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20220922112716

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: VALLE VERDE	FACILITY NUMBER: 421700411
	VISIT DATE: 08/10/2023

NARRATIVE

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On 09/27/22, LPA interviewed staff members and obtained records/documentation of medication for residents and the Centrally Stored Medication and Destruction Record. Medication records for September 2022 are documented appropriately with no inconsistencies or absence of documentation. There is no documented evidence to corroborate the allegation. No witnesses interviewed stated seeing or receiving any incorrect medications. On 08/10/2023, separate LPA reviewed the Centrally Stored Medication and Destruction Record for the assisted living portion of the facility. LPA also obtained copies of resident medication records and physician order reports for residents, maintained in each resident’s record/file. LPA observed that all the correct/proper medications were logged as having been given to each resident, and an audit of the actual medications stored in the assisted living portion of the facility matched the records maintained by the facility.

Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, it is deemed Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted. A copy of the report issued to the Administrator.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian Phillips	TELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

LIC9099 (FAS) - (06/04)

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