565801637-5-12-2023-29-AS-DPEA-CSD3M9-20230531182156

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801637
Report Date: 05/12/2023
Date Signed: 05/12/2023 04:35:35 PM

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
04/12/2023 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20230412151519

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:	05/12/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Julian Bond		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility parking lot is unsafe resulting in resident suffering a fall.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Esther Cortez conducted a subsequent complaint visit to the above facility at 1:00 p.m. LPA met with Administrator Julian Bond and the reason for the visit was explained. Findings were delivered to Administrator Julian Bond.

On 4/20/2023, LPA toured the facility with Hospital Administrative Resident 2 (HOR2) Cindy Gambill between 10:28 a.m. – 10:40 a.m., observed the parking lot during the tour, and requested copies of pertinent documents. Between 11:00 a.m. – 4:25 p.m. LPA interviewed nine (9) staff and five (5) residents. During today’s visit LPA conducted a file review and obtained pertinent documentation between 01:20 p.m. and 04:15 p.m.

Report will continue on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

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 2

Control Number 29-AS-20230412151519

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: VETERANS HOME OF CALIFORNIA-VENTURA	FACILITY NUMBER: 565801637
	VISIT DATE: 05/12/2023

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

It was alleged facility parking lot is unsafe resulting in resident suffering a fall. It was further reported that multiple residents have tripped over the parking lot wheel stops and injured themselves. Interviews conducted and observations made during the facility tour during the investigation reflected that the facility’s parking lot has no visible hazards or obstructions making the parking lot unsafe. Interviews also revealed that the wheel stops placed in all handicap parking spaces is to assist drivers with parking their vehicles and prevent vehicle overhangs from blocking the sidewalks. Furthermore, five (5) of five (5) residents stated they consider the parking lot to be safe. As an added precaution, during today’s visit, a discussion was held between LPA and the facility administrator regarding the possibility of ensuring that all wheel stops contrast with the surrounding pavement, similar to the black and yellow in comparison to the rest gray cinder block wheel stops. Based on information gathered, the Department does not have sufficient evidence to determine that facility parking lot is unsafe resulting in resident suffering a fall. Therefore, the above allegation is deemed UNSUBSTANTIATED at this time.

No citations were issued. Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2