565801637-7-12-2024-29-AS-KHEN-D7FVUV-20240723164521

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801637
Report Date: 07/12/2024
Date Signed: 07/12/2024 12:07:19 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
02/28/2024 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20240228090830

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: 56	DATE:	07/12/2024
		UNANNOUNCED	TIME BEGAN:	11:32 AM
MET WITH:	Ray Sena		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Neglect/Lack of Supervision: Resident #1 (R1) used illegal drugs at the facility while under the care of the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA met with pending Administrator Ray Sena and explained the reason for the visit.

On 02/28/2024, the Woodland Hills North Adult and Senior Care office received a complaint of neglect/lack of supervision. Resident #1 (R1) used illegal drugs at the facility while under the care of the facility. The complaint was referred to the Community Care Licensing Division (CCLD) Investigations Branch (IB) and assigned to Investigator Laarni Santiago.

On 03/06/2024, from 9:30am to 1:15pm, Licensing Program Analyst (LPA) Kelly Dulek conducted an initial complaint investigation for the allegation listed above. LPA Dulek arrived at the facility at 9:30am and met

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: 07/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024

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-20240228090830

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: 07/12/2024

NARRATIVE

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with the Administrator/Hospital Administrative Resident (HAR) II Cynthia Gambill and the pending Administrator Ray Sena. An entrance interview was conducted. During the visit, the LPA interviewed both members of the Management team at 9:36am, reviewed and received copies of pertinent documents, and toured the facility at 11:50am. No immediate health and safety hazards were identified during the visit. The LPA determined further investigation was needed to determine findings for the above allegation. Management was made aware that the allegation was referred to and accepted for investigation by the Community Care Licensing Division (CCLD) Investigations Branch (IB) and assigned to Investigator Laarni Santiago.

Investigator Santiago conducted interviews on 03/22/2024, at approximately 10:41am, with the Assistant Administrator; on 04/05/2024, from approximately 2:01pm to 3:00pm, with the Administrator, Resident #1 (R1), and a facility resident; on 05/31/2024, from approximately 10:53am to 12:00pm, with Supervising Registered Nurse, Supervising Psychiatric Social Worker, a facility resident, and Registered Nurse Infection Preventionist; on 06/04/2024, from approximately 10:02am to 6:11pm, with facility attorney, Witness #1 (W1), the Long-Term Care Ombudsman (LTCO), and the facility attending physician. In addition, the investigator reviewed Ventura County Medical Center (VCMC) records, Community Memorial Hospital (CMH) records, and facility file documents related to R1.

A review of R1’s preplacement appraisal, dated 09/09/2021, revealed R1 denied that they had a history of substance abuse but reported that they last used cocaine “2 years ago.” R1 had a history of substance use disorder (SUD) treatment. R1’s physician report, dated 03/09/2022, listed the diagnosis as A-fib, Hypertension, Diabetes Type II, Ambulatory, independent with all capacities of self-care and medication management, able to leave the facility unsupervised, able to follow instructions, and able to communicate needs.

According to the VCMC medical records, the records documented that R1 tested positive for amphetamine on 08/07/2023. The CMH lab results indicated R1 tested positive for amphetamine on six (6) different dates from the period of 08/27/2023 to 01/30/2024.

The Department’s investigation revealed R1 was admitted to the facility on 06/09/2022 but the staff were unaware of R1 being under the influence until R1 tested positive for amphetamines in August 2023. On
Report Continued on LIC 9099-C

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240228090830

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: 07/12/2024

NARRATIVE

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08/05/2023, R1 was admitted to the VCMC for heart failure, blood clot in leg and testicular pain. As part of the evaluation and management of acute conditions, a urine toxicology screen was done by the hospital team, and R1 tested positive for amphetamine on 08/07/2023. Interviews with staff and outside sources revealed that the facility was not aware of R1’s substance abuse until R1 was admitted to the hospital. The facility referred R1 to a substance use disorder (SUD) treatment program multiple times and conducted random weekly drug screenings. When R1 declined to attend an SUD treatment program and continued to test positive for meth/amphetamine, R1 was given a Code of Conduct letter and warned of a possible eviction. The facility staff sought the California Department of Veterans Affairs (CalVet) legal team to work on R1’s eviction procedures and R1 was served an eviction notice on 03/13/2024. However, the legal team revealed that R1 could not be evicted without going through the court and legal proceedings. Furthermore, that “CalVet is limited by law and regulations for the reasons to which they could evict.” The facility staff and CalVet’s legal team did not have supporting evidence to prove that R1 was using drugs in the property as R1 was independent and could leave the facility unsupervised. Staff denied that they allowed R1 to use illicit drugs at the facility but advised that they wanted to give R1 an opportunity to get help before evicting R1.

The facility took steps to initiate the eviction process which was filed by the Superior Court of California County of Ventura on 04/15/2024. A settlement was reached in court and R1 was allowed to remain at the facility if R1 did not violate the stipulations written in the Terms of Agreement dated, 05/23/2024 (Last Chance Agreement). As of 05/31/2024, R1 remained at the facility and staff interviews revealed that R1 had been testing negative for illegal drugs since R1 was served their eviction notice. During today's visit, pending Administrator informed LPA that R1 was admitted this morning to a SUD treatment program where R1 will remain for a minimum of 30-day treatment.

Based on interviews conducted and records reviewed, although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the allegation “Neglect/Lack of Supervision: Resident #1 (R1) used illegal drugs at the facility while under the care of the facility” is deemed Unsubstantiated at this time.

Exit interview conducted, 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: 07/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024

LIC9099 (FAS) - (06/04)

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