565801637-4-5-2023-29-AS-DPEA-CR4TA2-20230421143251

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801637
Report Date: 04/05/2023
Date Signed: 04/05/2023 11:38:04 AM

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
03/30/2023 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20230330133309

FACILITY NAME:	VETERANS HOME OF CALIFORNIA-VENTURA		FACILITY NUMBER:	565801637
ADMINISTRATOR:	JULIAN BOND		FACILITY TYPE:	740
ADDRESS:	10900 TELEPHONE ROAD		TELEPHONE:	(805) 659-7515
CITY:	VENTURA	STATE: CA	ZIP CODE:	93004
CAPACITY:	60	CENSUS: 55	DATE:	04/05/2023
		UNANNOUNCED	TIME BEGAN:	09:37 AM
MET WITH:	Julian Bond, Cindy Gambill		TIME COMPLETED:	11:47 AM

ALLEGATION(S):

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Facility did not provide adequate meal service to residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced initial complaint visit to this facility for the above complaint allegation. LPA arrived at 09:37AM, met with Administrator Julian Bond, and discussed the reason for today's visit.

During today's visit LPA interviewed staff from 09:55AM to 10:12AM and at 10:56AM, toured the dining room and kitchen areas with the Food Service Director and Facility Designee at 10:13AM, interviewed random residents from 10:19AM to 10:55AM, observed lunch service at 11:28AM and obtained copies of pertinent documents. The following was then determined:

It was alleged that one morning food service was inadequate, as residents were only served cold cereal for breakfast. Interviews revealed that on the morning of 03/27/2023, the kitchen vents were noted as inoperable. For safety reasons, the menu items listed, bacon and blueberry pancakes, were unable to be
Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

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-20230330133309

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: 04/05/2023

NARRATIVE

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prepared at that time. Staff interviews revealed that all items listed on the always available menu were available on that date. Instead of the regular menu items listed for 03/27/2023, kitchen staff prepared cold cereals, hot cereals such as grits, oatmeal, and cream of wheat, as well as toast, bagels, hard boiled eggs, both fresh fruit and canned fruit. Residents also had the option for various yogurts, juices, snacks and regular beverage items. Staff indicated the only 2 items not available on that date were bacon and blueberry pancakes. Interview revealed that when residents arrived at the dining room, staff communicated to the residents that menu items were unavailable. Resident interviews revealed that for the most part, residents are happy with the food service, there are many options available, and there hasn't been any day that residents can recall that there were not sufficient available options for meal service. Residents did comment that diabetic menu choices are limited, but there are still some choices to meet resident needs. LPA observed adequate food supply available during today's visit and food service observed during today's visit followed the printed menu and appeared adequate. Therefore, based on interview and observation, there is insufficient evidence to support the allegation or that a violation occurred; as thus, the allegation "facility did not provide adequate meal service to residents in care" is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted with Facility Designee Cindy Gambill. A copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

LIC9099 (FAS) - (06/04)

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