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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 421703604
Report Date: 01/04/2024
Date Signed: 01/04/2024 03:58:11 PM

Substantiated


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
10/11/2023 and conducted by Evaluator Brian Phillips
COMPLAINT CONTROL NUMBER: 29-AS-20231011194611
FACILITY NAME:ORCUTT BOARD AND CARE HOMEFACILITY NUMBER:
421703604
ADMINISTRATOR:ANNIE YAGUEFACILITY TYPE:
740
ADDRESS:263 CRESCENT AVE.TELEPHONE:
(805) 934-2586
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:6CENSUS: 4DATE:
01/04/2024
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Nelson Yague, LicenseeTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility does not provide a safe environment for resident while in care.
INVESTIGATION FINDINGS:
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On 01/04/2024, Licensing Program Analyst (LPA) Brian Phillips conducted an unannounced subsequent complaint visit to the facility above to issue final findings on the allegations above. LPA arrived at the facility, met with Licensee Nelson Yague, and announced the purpose of the visit.

On the allegation: Facility does not provide a safe environment for resident while in care. It is alleged by the Reporting Party (RP) that Resident #1 (R1) has been put into a bedroom of the facility that has the only access to the back parking area of the facility. Allegedly R1 is not allowed to lock the bedroom door because it is the only access into the facility from the back lot, and R1 has multiple people entering and exiting the home through the bedroom of R1.

On 10/12/2023, LPA conducted a complaint investigation visit to the facility above that included interviews with residents, staff, a record review of pertinent facility documentation, and a tour of the physical plant of the facility. Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian PhillipsTELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
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 5
Control Number 29-AS-20231011194611
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: ORCUTT BOARD AND CARE HOME
FACILITY NUMBER: 421703604
VISIT DATE: 01/04/2024
NARRATIVE
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Through LPA observation, record review of a Facility Sketch, and the facility LIC 610 Emergency Disaster Plan documentation, LPA identified facility exit locations at the front entrance door of the facility, sliding glass door in the living room of the facility, and back door(s) out of the facility located in two (2) separate resident bedrooms. On 10/12/2023, LPA observed that the back door of a resident bedroom in the facility is an exit out of the facility that connects to the back/side of the facility or “back lot.” On 10/12/2023, interviews with residents indicated that that individuals would use a resident bedroom to enter and exit the facility from the “back lot” area of the facility. At least 1 Staff member interviewed by LPA indicated that the back entrance in R1’s room was the easiest way to enter and exit the facility from the outside area of the facility. The other resident bedroom backdoor that exits to the outside of the facility is located on the opposite side of the facility away from the “back lot” area and was not mentioned through interviews as having been used by individuals to enter and exit the facility.

According to California Code of Regulations Section 87307(a)(2)(C) Personal Accommodations and Services, living accommodations and grounds shall be related to the facility's function. The following provisions shall apply: Resident bedrooms shall be provided which meet, at a minimum, the following requirements: No bedroom of a resident shall be used as a passageway to another room, bath, or toilet. In this instance, a resident bedroom has a door remain unlocked because it is the only access into the facility from the “back lot” area of the facility, and multiple individuals use the resident bedroom as a passageway into and out of the facility.

Based on the information obtained, there was sufficient evidence to prove the allegation. Therefore, the allegation is deemed Substantiated at this time.

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

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian PhillipsTELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
10/11/2023 and conducted by Evaluator Brian Phillips
COMPLAINT CONTROL NUMBER: 29-AS-20231011194611

FACILITY NAME:ORCUTT BOARD AND CARE HOMEFACILITY NUMBER:
421703604
ADMINISTRATOR:ANNIE YAGUEFACILITY TYPE:
740
ADDRESS:263 CRESCENT AVE.TELEPHONE:
(805) 934-2586
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:6CENSUS: 4DATE:
01/04/2024
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Nelson Yague, LicenseeTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff does not ensure that resident has access to a wheelchair accessible shower while in care.
INVESTIGATION FINDINGS:
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On 01/04/2024, Licensing Program Analyst (LPA) Brian Phillips conducted an unannounced subsequent complaint visit to the facility above to issue final findings on the allegations above. LPA arrived at the facility, met with Licensee Nelson Yague, and announced the purpose of the visit.

On the allegation: Staff do not ensure that resident has access to a wheelchair accessible shower while in care. It is alleged by RP that there is no shower that would be accessible for R1 in their wheelchair. RP alleged that not giving R1 a shower and only washing/bathing certain areas of R1 because of the lack of wheelchair accessibility in the bathroom constitutes neglect.

On 10/12/2023, LPA conducted a record review of facility documentation, interviewed Staff members, interviewed residents, and toured the physical plant of the facility during the complaint investigation visit. This facility has 4 total resident restrooms, with 2 restrooms containing a shower/tub for the washing and bathing of residents. Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian PhillipsTELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20231011194611
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: ORCUTT BOARD AND CARE HOME
FACILITY NUMBER: 421703604
VISIT DATE: 01/04/2024
NARRATIVE
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All the restrooms in the facility have similar measurement dimensions averaging 5 feet in width and 8 to 10 feet in length. Both shower/bathtubs in the facility do not have the size/dimensions for a wheelchair to access the bathing/washing areas by rolling straight in from the facility hallway or interior restroom toilet area. On 12/05/2023, LPA conducted additional observation of each restroom in the facility and took photographic evidence of each shower/tub and/or washing/bathing area. Each washing/bathing area in each facility restroom has a raised edge higher than the floor of the facility, meaning a wheelchair is unable to freely roll into the bathtub/shower area of each facility restroom. However, all restrooms inspected had assistive equipment for residents including grab bars and/or non-skid surfaces. Each resident restroom also contains a folded wheelchair located at the edge of the bathtub/shower to transfer residents into the bathing/washing area.
Licensing does not require facilities to make structural modifications to the physical plant of the building to accommodate the accessibility of resident assistant devices such as wheelchairs. Licensing regulations dictate that resident bedrooms, but not resident bathrooms, meet the requirement to be large enough to allow for easy passage between and comfortable usage of beds and other required items of furniture, and any resident assistant devices such as wheelchairs or walkers. The licensing agency may require the facility to acquire a local building inspection where Licensing determines that a suspected hazard to health and safety exists. However, there is no suspected hazard to health or safety as R1 is still being cleaned hygienically by the facility through the washing of private areas and the changing of diapers on a regularly scheduled basis. It is the duty/responsibility of the Responsible Party and/or Conservator for each resident to make sure that the prospective facility restrooms have the necessary space for the individual resident’s wheelchair prior to moving the resident into the facility.

The California Building Code states in existing buildings or facilities, when the enforcing agency determines that compliance with any building standard under toilet accessibility would create an unreasonable hardship, an exception to such standard may be granted when equivalent facilitation is provided. Here, Licensing has determined that there is no unreasonable hardship, and additionally there is equivalent facilitation as R1 is still being cleaned hygienically through the washing of private areas and the changing of diapers on a regularly scheduled basis. The facility also provides a transfer wheelchair to assist residents into the shower/tub for bathing/washing, and each restroom is equipped with assistive grab bars and non-skid surfaces.

Based on the information obtained, there was Insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Exit Interview conducted. Copy of Report given to facility.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian PhillipsTELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20231011194611
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: ORCUTT BOARD AND CARE HOME
FACILITY NUMBER: 421703604
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/01/2024
Section Cited
CCR
87307(a)(2)(C)
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87307(a)(2)(C) Personal Accommodations and Services. (a)Living accommodations...the following provisions shall apply: (2) Resident bedrooms provided which meet…following requirements: (C) No bedroom of resident shall be used as passageway to another room, bath, or toilet.
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The Administrator of the facility will provide the LPA with evidence that Staff and other individuals entering and exiting the facility will be trained on Resident Personal RIghts regarding personal accommodations. All individuals will cease using resident bedrooms as passageways immediately.
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This requirement was not met by: Based on interview, observation, and record review the facility used the bedroom of a resident as a passageway for individuals to enter and exit the facility.
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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: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian PhillipsTELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5