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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801637
Report Date: 01/03/2023
Date Signed: 01/03/2023 02:55:51 PM

Substantiated


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
11/17/2021 and conducted by Evaluator Angel Ascencio
COMPLAINT CONTROL NUMBER: 29-AS-20211117090131
FACILITY NAME:VETERANS HOME OF CALIFORNIA-VENTURAFACILITY NUMBER:
565801637
ADMINISTRATOR:JULIAN BONDFACILITY TYPE:
740
ADDRESS:10900 TELEPHONE ROADTELEPHONE:
(805) 659-7515
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY:60CENSUS: 57DATE:
01/03/2023
UNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Julian BondTIME COMPLETED:
10:31 AM
ALLEGATION(S):
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Staff engaged in verbal altercations with residents in care
Staff speaks inappropriately to residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angel Ascencio conducted a subsequent visit to deliver the finding to the above facility. The LPA met with Administraor Julian Bond at 9:20 a.m. and discussed the reason for visit.

On 11/17/2021, the Department received a complaint alleging that staff engaged in verbal altercation with residents in care and staff speaks inappropriately to residents. An interview with the Administrator Julien Bond on 11/19/2021, starting at around 1:05 p.m., revealed that they have yet to receive any written statement from Staff #1 (S1) and Resident #1 (R1) regarding the alleged altercation. Administrator Bond stated that the supposed incident happened due to a high-profile trial; and, that in addition to the alleged verbal altercation, R1 had allegedly choked S1 near the office early in the morning on 11/15/2021. Administrator Bond also added that the surveillance tapes have been checked and nothing could be seen from the alleged incident. During the investigation, R1 was interviewed and confirmed that R1 did not put hands on S1. S1 stated that R1 attempted to choke S1, but S1 was able to evade R1.
Continued on LIC 9099- C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2023
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 5
Control Number 29-AS-20211117090131
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: VETERANS HOME OF CALIFORNIA-VENTURA
FACILITY NUMBER: 565801637
VISIT DATE: 01/03/2023
NARRATIVE
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Lastly, since the day of the alleged incident, Administrator Bond conducted an all staff training on the Code of Conduct for all employees. LPA Ascencio received a copy of the Code of Conduct handout.

On 12/01/2021, LPA Ascencio conducted S1’s interview starting at 2:50 p.m. The interview with S1 revealed that on 11/15/2021 at approximately 2:50 p.m., S1 was called over to a table that R1 and other residents were sitting. S1 was questioned by R1 what their stance was on a political view. S1 responded. R1 was visibly upset by the response. A further interview with S1 revealed that on 11/16/2021, starting at approximately 7:00 a.m., S1 walked into the building to find R1 yelling and calling S1 racist names. S1 stated they jokingly went along with the name calling. R1 stated that S1 is a “white supremist” and eventually lifted up their hood as if they were a ”KKK” member. S1 stated they know they should not have engaged with R1 and should have changed their approach about the situation.

An interview with R1, on 11/17/2022, starting at 9:30 a.m. revealed that on 11/15/2021 at approximately 3:00 p.m., R1 called S1 to the table where R1 was sitting to discuss a high-profile trial. R1 informed the LPA of the comments that S1 allegedly made. R1 added that S1 was also talking about former President, Donald Trump and S1’s views on him. R1 continued, the next day, on 11/17/2021 at around 6:45 a.m., R1 was in the gym and noticed S1 walk in the door. S1 noticed R1 and started talking about their political views to R1, continuing the conversation from the previous day. R1 stated R1 took offense to what S1 was saying and began recording a video engaging S1 and calling S1 a “white supremist” and member of the “KKK.” R1 added that S1 admitted to being a “white supremist” and put their hood up. The LPA was not able to observe the alleged recording; however, interviews on 11/19/2021 and 12/01/2021 with S1, S2, S3, and S4, all confirmed that they watched the video and witnessed S1 having a verbal altercation with R1 and observed S1 stating that S1 was a “white supremist, KKK member” and putting their hood up.

Based on evidence gathered throughout the investigation, although S1 stated that they were joking when they the verbal altercation, which resulted in S1 speaking inappropriately to R1, the allegations are deemed substantiated at this time.

SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2023
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
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
11/17/2021 and conducted by Evaluator Angel Ascencio
COMPLAINT CONTROL NUMBER: 29-AS-20211117090131

FACILITY NAME:VETERANS HOME OF CALIFORNIA-VENTURAFACILITY NUMBER:
565801637
ADMINISTRATOR:JULIAN BONDFACILITY TYPE:
740
ADDRESS:10900 TELEPHONE ROADTELEPHONE:
(805) 659-7515
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY:60CENSUS: 57DATE:
01/03/2023
UNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Julian BondTIME COMPLETED:
10:31 AM
ALLEGATION(S):
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2
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9
Staff threatens residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angel Ascencio conducted a subsequent visit to deliver the finding to the above facility. LPA met with Administrator Julian Bond at 9:20 a.m. and discussed the reason for visit.

On 11/17/2021, the Department received a complaint alleging that staff threatens residents in care. The complainant further added that they believe that the work environment is hostile and unsafe for employees and other residents. In addition, the complainant was also concerned that Resident #1 (R1) also threatens residents in care. On 12/01/2021, LPA Ascencio conducted an interview with Staff #1 (S1) starting at 2:50 p.m. The interview with S1 revealed that on 11/15/2021, at approximately 2:50 p.m., S1 was called over to a table where Resident #1 (R1) and other residents were sitting. S1 was questioned by R1 what their stance was on a political view. S1 made a comment. R1 was visibly upset.

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2023
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-20211117090131
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: VETERANS HOME OF CALIFORNIA-VENTURA
FACILITY NUMBER: 565801637
VISIT DATE: 01/03/2023
NARRATIVE
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S1 further revealed that on 11/16/2021, starting at approximately 7:00 a.m., S1 walked into the building to find R1 yelling and calling S1 names like a “white supremist” and a “member of the KKK.” S1 stated they jokingly went along with the name calling stating that S1 was a “white supremist” and eventually lifting up their hood as if they were a ”KKK” member. S1 stated they know they should not have engaged with R1 and should have changed their approach about the situation.

An interview with R1, on 11/17/2022, starting at 9:30 a.m. revealed that on 11/15/2021, at approximately 3:00 p.m., R1 called S1 to the table where they were sitting to discuss a high-profile trial. R1 said that S1 made an inappropriate comment. R1 stated R1 did not feel threatened by S1’s statements. R1 continued, the next day, 11/17/2021, at around 6:45 a.m., R1 was in the gym and noticed S1 walk in the door. S1 noticed R1 and started talking about their political views to R1, continuing the conversation from the previous day. R1 stated R1 took offense to what S1 was saying and began recording a video engaging S1 and calling S1 a “white supremist” and member of the “KKK.” R1 added that S1 admitted to being a “white supremist” and put their hood up. R1 again added that they did not feel threatened or was threatened by S1.

Regarding whether R1 was threatening to residents in care, staff did not bring up the issue to LPA Ascencio, though they did mention that R1 can be intimidating to staff at times. Residents were also interviewed, and they mentioned that they haven’t heard or witnessed R1 being intimidating or threatening, but more observed R1 as being a spokesperson to those who don’t have a voice or are unable to say anything.

Based on evidence gathered, the allegation that staff threatens residents in care, is deemed unsubstantiated at this time.

Exit interview conducted and copy of the report provided to the administrator via email.

SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20211117090131
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: VETERANS HOME OF CALIFORNIA-VENTURA
FACILITY NUMBER: 565801637
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/04/2023
Section Cited
CCR
87468.1(a)(1)
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87468 Personal Rights of Residents in all
Facilities (a)(1) Each resident shall be
accorded dignity in his/her personal
relationships with staff, residents and other
persons.

This requirement was not met as evidenced by:
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Admin will have Ombudsman provide conduct training on 87468 (a)(1) to all staff. Admin will provide training materials and attendees of the training to CCL 01/27/2023.
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Based on interviews, the licensee did not
comply with the section cited above as S1 engaged with R1 inappropriately which poses an immidiate health, safety and personal
rights risk to persons in care.
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ILS
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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: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5