565801637-5-25-2023-29-AS-DPEA-CSD3M8-20230531182156

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801637
Report Date: 05/25/2023
Date Signed: 05/25/2023 04:33:34 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:	05/25/2023
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Cindy Gambill- Hospital Administrative Resident 2		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Facility did not notify resident's responsible party of an incident.
Facility did not seek medical treatment for resident in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Esther Cortez conducted a subsequent complaint visit to the above facility at 2:40 p.m. LPA met with Hospital Administrative Resident 2 (HOR2) Cindy Gambill and the reason for the visit was explained. Administrator Julian Bond was notified of the visit and directed LPA to HOR 2 Cindy Gambill to issue the findings of today's report..

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. On 5/12/2023 LPA conducted a file review and obtained pertinent documentation between 01:20 p.m. and 04:15 p.m. During today's visit LPA conducted a file review between 2:50 p.m. and 4:15 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: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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-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: 05/25/2023

NARRATIVE

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It was alleged facility did not notify resident’s Responsible Party (RP) of an incident. It was further reported that R1’s emergency contact was not notified of a fall. Administrator indicated that resident’s emergency contacts are not notified of resident’s incidents if, they are not the residents’ responsible party, unless it is a critical medical situation where the resident is unable to make that decision. In addition, the administrator stated that in case of a serious incident, staff will assess the resident and if they are oriented and able, staff will ask the resident if they want their emergency contacts to be notified. A review of Unusual/Serious Injury Reports (SIRs) submitted to the department reflected that Resident #1s (R1) incident was reported to the licensing agency, however R1 is their own responsible party and therefore the facility did not have to notify R1’s emergency contacts. Additionally, interviews conducted with random facility residents reflected that their RPs are notified in case of emergency however, if the resident choose the RP to not be notified the facility would respect the residents wishes. LPA also conducted interview with random RPs of facility residents which reflected that they are notified of any incidents pertaining to the residents. Based on information gathered, the Department does not have sufficient evidence to determine that facility did not notify resident’s responsible party of an incident. Therefore, the above allegation is deemed UNSUBSTANTIATED at this time.

It was alleged facility did not seek medical treatment for resident in a timely manner. It was further reported R1 was denied medication when they requested it and not taken to the hospital in a timely manner. Interviews conducted revealed that when residents are ill, residents are assessed by facility’s nurses and resident’s Primary Care Physician (PCP) to determine the medical treatment needed. If it is an urgent medical concern, the facility will immediately contact 9-1-1 emergency services to transport residents to the hospital. Moreover, interviews conducted reflected that R1 was diagnosed with COVID-19 and R1’s PCP was notified. Based on recommendation of the PCP, R1 was not given the medication for COVID due to possible medication contradictions with the current medication R1 was taking. Moreover, a review of R1’s medication records reflected that R1 did not have a prescription for Ibuprofen and therefore, the facility could not assist R1 with self-administration of medication. However, upon discharge from the hospital R1 received a new prescription order for the medication and therefore, was provided the medication. Based on information gathered, the Department does not have sufficient evidence to determine that Facility did not seek medical treatment for resident in a timely manner Therefore, the above allegation is deemed UNSUBSTANTIATED at this time.
No citations were issued. Exit interview conducted with HOR2 Cindy Gambill. 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: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

LIC9099 (FAS) - (06/04)

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