565801637-3-6-2024-29-AS-KHEN-D4PNJF-20240426103015

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801637
Report Date: 03/06/2024
Date Signed: 03/06/2024 01:11:36 PM

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
03/06/2024 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20240306122033

FACILITY NAME:	VETERANS HOME OF CALIFORNIA-VENTURA		FACILITY NUMBER:	565801637
ADMINISTRATOR:	CYNTHIA GAMBILL		FACILITY TYPE:	740
ADDRESS:	10900 TELEPHONE ROAD		TELEPHONE:	(805) 659-7501
CITY:	VENTURA	STATE: CA	ZIP CODE:	93004
CAPACITY:	60	CENSUS: 57	DATE:	03/06/2024
		UNANNOUNCED	TIME BEGAN:	12:36 PM
MET WITH:	Cynthia Gambill		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff does not keep residents rooms free from odor.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted an initial complaint investigation for the allegation listed above. LPA arrived at the facility at 09:30AM for an unrelated visit and met with Hospital Administrative Resident (HAR) II Cynthia Gambill and pending Administrator Ray Sena. Entrance interview conducted. As this complaint was received during the unrelated visit, LPA discussed this allegation with HAR II 12:54PM.

During today's visit, LPA interviewed both members of the Management team at 09:36AM and HAR II again at 12:54 PM and toured the facility at 11:50 AM. The following was then determined:

During facility tour, LPA did not note any odors in the facility common areas nor in the rooms toured, which included a selection of those listed in the complaint allegation. Interview with management revealed that residents are responsible for maintaining their own personal living space, but the facility does offer

Report 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: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

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-20240306122033

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: 03/06/2024

NARRATIVE

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housekeeping services daily to include vacuuming, emptying trash and cleaning resident restrooms. Residents do maintain the right to refuse housekeeping services, however, the facility does have a code of conduct which includes a statement that "each resident is required to maintain or cooperate with staff in maintaining his or her living area in a safe, clean, neat and sanitary condition." Interview with management revealed that when residents do not comply with the Code of Conduct, they are issued a violation and encouraged to participate in a compliance plan. At the time of today's visit, no odors were observed in the facility and Management indicated there have been no noticeable odors brought to their attention recently. Based on interview and observation, although the allegation may be valid, at this time, there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that "staff does not keep residents rooms free from odor" is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted. A copy of today's 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: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

LIC9099 (FAS) - (06/04)

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