565800734-8-29-2024-29-AS-DPEA-D9HN5X-20240927101012

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565800734
Report Date: 08/29/2024
Date Signed: 08/29/2024 02:14:47 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
04/19/2024 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20240419133829

FACILITY NAME:	HILLCREST ROYALE		FACILITY NUMBER:	565800734
ADMINISTRATOR:	INGA JAKOBOVICH		FACILITY TYPE:	740
ADDRESS:	190 EAST HILLCREST DRIVE		TELEPHONE:	(805) 371-0035
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	145	CENSUS: 89	DATE:	08/29/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Michelle Gubbay		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff does not provide a comfortable room temperature for resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit for the purpose of continuing the investigation for the above allegation. Upon arrival, LPA met with the Director of Services, Michelle Gubbay and the reason for the visit was explained. Entrance interview conducted.

During the initial visit on 04/26/2024, LPA Arroyo conducted a plant tour to ensure there were no health and safety concerns at 2:42 p.m., conducted interviews with two (2) staff members between 2:35 p.m. and 3:30 p.m., and obtained a copy of the resident roster. During today’s visit, LPA Arroyo conducted interviews with one (1) staff and nine (9) residents starting at 11:15 a.m. and obtained copies of pertinent documents.

Report Continued on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

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

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240419133829

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: HILLCREST ROYALE	FACILITY NUMBER: 565800734
	VISIT DATE: 08/29/2024

NARRATIVE

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Report Continued from LIC 9099...

It was alleged that staff does not provide a comfortable room temperature for resident. It was the complainant’s concern that the facility’s heater has been in disrepair for a couple months and the resident rooms were getting cold. Records reviewed and interviews conducted revealed that the facility began renovation to install a new air conditioner and heating system; however, residents and family members were notified prior to the company hired coming out to the facility and begin working. Notices were also posted in common areas to inform the residents of the facility’s upgrades. Staff interviews revealed that upon completion, several rooms did not have a functioning air system; however, the facility provided all residents that were affected a portable air conditioner and a small room heater. Interviews conducted with resident revealed that a heater was provided by the facility when the heating system malfunctioned, which helped keep their rooms warm during the cold season. Also, residents reported receiving a portable air conditioner from the facility without requesting. Furthermore, nine (9) out of nine (9) residents interviewed did not report having any concerns living at the facility or with the temperature in their bedrooms. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “staff does not provide a comfortable room temperature for the resident”. Therefore, this allegation is being deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. Report was reviewed and a copy issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

LIC9099 (FAS) - (06/04)

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