425800215-2-26-2025-29-AS-KBUY-DEAQKM-20250227111435

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425800215
Report Date: 01/16/2025
Date Signed: 02/26/2025 10:56:16 AM

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
12/18/2024 and conducted by Evaluator Brian Phillips

COMPLAINT CONTROL NUMBER: 29-AS-20241218100211

FACILITY NAME:	MCMILLAN RANCH		FACILITY NUMBER:	425800215
ADMINISTRATOR:	MARTHA MANCHA		FACILITY TYPE:	735
ADDRESS:	3840 ORCUTT GAREY ROAD		TELEPHONE:	(805) 937-2826
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93455
CAPACITY:	10	CENSUS: 9	DATE:	01/16/2025
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Martha Mancha, Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff do not ensure resident's hygiene needs are met
Staff are mismanaging resident's medication
Staff do not provide activities to resident
Staff do not allow resident to have visitors

INVESTIGATION FINDINGS:

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This is an amended report. LPA Rankin conducted an unannounced subsequent complaint investigation visit and delivery of final findings to the facility above. Previously on 1/16/2025, LPA Phillips conducted a subsequent visit. During the investigation conducted by LPA Phillips, on 12/19/2024 from 10:30am to 1:30pm, LPA interviewed staff, clients, family members of clients, and obtained relevant documents. LPA Rankin conducted additional interviews on 2/21/2025 with Administrator and Public Guardian. On 2/26/25, LPA Rankin arrived at the facility, met with Caregiver on site who confirmed via phone discussion with the administrator that Caregiver could sign the report, and announced the purpose of the visit.
On the allegation: Staff do not ensure resident's hygiene needs are met. It is alleged facility staff would not let a client shower and are not assisting client with grooming because they are not clean shaven.
LPA requested and received facility documentation including Preplacement Appraisal Information, Physician’s Report for Community Care Facilities, and Functional Capability Assessment all for Client 1 (C1). All documentation for C1 states that C1 can bathe/shower without help and handles their own personal hygiene. Contd. 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

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 4

Control Number 29-AS-20241218100211

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: MCMILLAN RANCH	FACILITY NUMBER: 425800215
	VISIT DATE: 01/16/2025

NARRATIVE

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This is an amended report. LPA also reviewed facility staff supervision and duty checklists for all shifts during each day. These checklists include marking designated client checks on the hour each hour with reminders to make sure each resident is appropriately groomed and has adequate hygiene cleanliness. LPA also conducted record review of client records on-site at the facility that included information on grooming/hygiene procedures for each client’s Activities of Daily Living (ADL) as well as the Needs and Services Plan for C1 which included documentation on cleaning/grooming. All clients interviewed by LPA stated that they regularly shower/bathe in the facility. All staff interviewed by LPA stated that clients who need assistance with grooming/bathing/hygiene are helped and all clients are regularly reminded to maintain appropriate hygiene. LPA observed clients in the facility to be adequately groomed, clothed, and bathed while in the facility during the complaint investigation. Based on the information gathered, there is insufficient evidence to prove staff do not ensure resident’s hygiene needs are met. Therefore, the allegation is Unsubstantiated.

On the allegation: Staff are mismanaging resident's medication. It was alleged staff provided C1 with the wrong medication(s).

LPA physically observed that the facility maintains a locked centralized storage area for resident medications. Centrally Stored Medications are in a locked storage containment area within the Staff office area/room of the facility, which is a set of cabinets/drawers that always remain locked, inaccessible/locked to residents. LPA observed Centrally Stored Medication and Destruction Record, The Medication Administration Record, and the record of Controlled Medications. LPA audited the medications for C1 and noticed no irregularities or issues concerning the dispensing of medications or the logging of medications. The medications in the facility were labeled appropriately with no additional or prohibited markings by the facility. LPA requested and received Physician Orders and hospitalization records regarding the prescribing of medications to C1. All medications being stored and dispensed by facility staff for C1 have been documented by medical professionals with instructions that are being appropriately followed by facility staff. The facility records and reviews C1's medication on a regular basis including comments and side effects experienced by C1. LPA received Informed Consent Forms for Psychotropic and Psychoactive Medications for C1 signed/dated by C1’s physician and C1’s legally appointed State Conservator. Based on the information gathered, there is insufficient evidence to prove staff are mismanaging resident’s medication. Therefore, the allegation is Unsubstantiated. Contd. 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20241218100211

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: MCMILLAN RANCH	FACILITY NUMBER: 425800215
	VISIT DATE: 01/16/2025

NARRATIVE

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This is an amended report. On the allegation: Staff do not provide activities to resident. It is alleged clients did not have activities at the facility.

LPA observed that the indoor common areas of the facility include a specified “activity room” for clients to utilize in the facility. There are activity supplies and equipment, including activity materials for the clients such as television, puzzles, games, toys/tools/equipment, etc. There are also activities available for clients such as board games, puzzles, and reading materials located in the dining room area. Clients interviewed by LPA stated they liked to do things in the facility such as reading books, playing games/puzzles, and/or watching television. The facility maintains documentation of client activities/outings through filling out an activity sheet for each client as well as a shift duty checklist. Based on the information gathered, there is insufficient evidence to prove staff do not provide activities to resident(s). Therefore, the allegation is Unsubstantiated.

On the allegation: Staff do not allow resident to have visitors. It is alleged that staff did not allow C1’s visitor (Person 1 – P1) to visit or speak to C1 on the phone.

LPA Phillips observed a central/initial sign-in area for visitors upon entering the facility. This area contained visitor logbooks for visitors to identify themselves, the date, time in/time out, and what client was being visited. The facility also keeps documented visitation logs for outside agencies visiting the facility. LPA received the facility visitor policy signed and dated by C1 stored in C1's facility file/record. Facility staff indicated C1’s conservator did not want P1 visiting C1. C1 is conserved by the Public Guardian’s office, and LPA Rankin reviewed C1’s conservatorship documents and interviewed Public Guardian (PG). PG stated C1 did not give a release of information that would allow P1 to visit or know where P1 was residing. Additionally, PG stated C1 did not want P1 to visit. As a result, PG confirmed they told facility staff P1 was not allowed to visit. Facility staff interviewed stated P1 was very disruptive when they attempted to gain entry to the facility, and staff had concerns for C1’s wellbeing. Based on the confirmation the PG instructed facility staff to not let P1 visit, the allegation is Unsubstantiated at this time. Contd. 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20241218100211

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: MCMILLAN RANCH	FACILITY NUMBER: 425800215
	VISIT DATE: 01/16/2025

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	This is an amended report. Exit interview conducted. Copy of this report provided to the facility.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4