565801019-7-30-2024-29-AS-DPEA-D7PU3N-20240731151349

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801019
Report Date: 07/29/2024
Date Signed: 07/30/2024 08:25:43 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
01/04/2023 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20230104090949

FACILITY NAME:	MOUNTAIN VISTA OF OJAI		FACILITY NUMBER:	565801019
ADMINISTRATOR:	NICKIE PEREZ		FACILITY TYPE:	740
ADDRESS:	602 EAST OAK STREET		TELEPHONE:	(805) 646-6850
CITY:	OJAI	STATE: CA	ZIP CODE:	93023
CAPACITY:	38	CENSUS: 25	DATE:	07/29/2024
		UNANNOUNCED	TIME BEGAN:	10:03 AM
MET WITH:	Nickie Perez		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff failed to treat resident with dignity and respect
Staff not providing adequate food service
Facility not providing a comfortable temperature for resident
Staff left resident in soiled diaper for extended period of time
Staff do not offer resident opportunity to exercise
Staff failed to provide proper hygiene to resident
Staff failed to elevate resident's feet

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint visit at the facility. LPA met with administrator Nickie Perez and explained the reason for the visit.

During LPA's visit on 1/12/2023, LPA interviewed staff and other witnesses, conducted a facility tour, inspected the food supply, observed residents eating lunch, reviewed surveillance video of incidents involving resident #1 (R1), obtained pertinent documents, and met with R1's family, Adult Protective Services Social Worker, and Ventura County Sheriff's Department deputies. On 7/29/2024, LPA conducted interviews with visitors, resident, and observed residents eating lunch.
Based on interviews with witnesses and residents, staff treat all residents with respect and kindness. There were no concerns voiced regarding how staff treat the residents, therefore the allegation staff failed to treat resident with dignity and respect is deemed Unsubstantiated at this time.

(continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024

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 2

Control Number 29-AS-20230104090949

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: MOUNTAIN VISTA OF OJAI	FACILITY NUMBER: 565801019
	VISIT DATE: 07/29/2024

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

(continued from LIC9099)

Based on interviews with witnesses and residents, the food at the facility is good and the serving sizes are large. The facility cook will ask "picky eaters" what they like to eat to try and accommodate them. LPA observed the food supply was abundant, with more than enough perishable and nonperishable foods. Therefore, the allegation staff was not providing adequate food service is deemed Unsubstantiated at this time.

Based on interviews with witnesses and residents as well as LPA's observations, the facility is kept at a comfortable temperature. Some residents may feel cold even if the facility temperature is at 78*F. They keep sweaters/jackets and blankets in case a resident feels chilly. Therefore, the allegation the facility is not providing a comfortable temperature for residents is deemed Unsubstantiated at this time.

Based on interviews with witnesses and residents, facility staff provide assistance with incontinence care. Staff respond to call buttons for assistance quickly, never more than 15 minutes wait time. Staff also assist with showers on a schedule or as needed. None of the witnesses had ever come into the facility and observed residents disheveled, needing incontinence care for a long period of time or smelling badly. Therefore, the allegations staff left resident in soiled diaper for extended period of time and staff failed to provide proper hygiene to resident are deemed Unsubstantiated at this time.

Based on interviews with witnesses and residents, facility staff will assist residents with mobility issues. They do not perform physical therapy (PT) on residents as this is not a rehabilitation facility with PT professionals, but they do assist residents with walking if the resident is physically capable of safely using a walker. Facility staff also offer chair exercise activites to the residents. Therefore, the allegation staff do not offer resident opportunity to exercise is deemed Unsubstantiated at this time.

Based on interviews with witnesses and residents, facility staff assist residents with circulation issues. Staff assist residents with elevating their feet while sitting in chairs, wheelchairs, or in bed throughtout the day. Therefore, the allegation staff failed to elevate resident's feet is deemed Unsubstantiated at this time.

No deficiencies were observed. Exit interview conducted and a copy of the report issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2