565801637-5-22-2023-29-AS-JAPL-CS7UZT-20230526160203

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801637
Report Date: 05/22/2023
Date Signed: 05/22/2023 10:25:00 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
03/15/2022 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20220315144546

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:	05/22/2023
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Julian Bond		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff did not notify resident's physician of resident's change of condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to issue the findings for the above allegation. The LPA met with staff and explained the reason for the visit.

It was alleged that Resident #1 (R1) experienced a change of condition and staff allegedly failed to notify R1’s psychiatrist. There was an overall concern for R1’s well-being due to the change of behavior. On 3/15/2022, Licensing Program Analyst (LPA) JoAnn Rosales made a visit to this facility from 10:26 a.m. – 1:45 p.m., to which the LPA interviewed staff, reviewed records, and obtained documents.

The investigation revealed that an incident report submitted to the Department dated 3/13/2022, indicated that on 3/13/2022, staff found a note written by R1, where R1 expressed that something ‘bad’ had happened and that it ‘had to be fixed’. R1 was not in the facility at the time the note was found. The incident report also indicated that R1’s attending physician (ie. Facility house doctor) was also notified of R1’s status.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023

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-20220315144546

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: 05/22/2023

NARRATIVE

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Staff contacted R1 over the phone on 3/13/2022, in which R1 was making suicidal ideations. In response, staff contacted the local police department and informed them of the incident. R1 ultimately returned to the facility on 3/14/2022. Staff met with R1, and although R1 appeared to be in a better mood, staff contacted the county suicide prevention hotline on 3/15/2022 for additional feedback. Staff encouraged R1 to contact emergency services if they continued to experience suicidal ideations. On 3/16/2022, R1 began to experience suicidal ideations, in which staff responded by contacting the local police department. Staff contacted emergency services, and R1 was ultimately transferred to a psychiatric unit and did not return to the facility.

Interviews and records review revealed that upon admission to the facility on 1/25/2018, R1 had a diagnosis of anxiety and depression. As a result, R1 had regularly consulted with a psychiatrist with regards to managing their diagnosis. Records documented that R1 was an ‘independent and active’ resident, owned their own vehicle, and participated in their own ‘self-directed activities’. A review of internal care notes confirmed that staff were aware of R1’s diagnosis and had regularly checked in with R1 regarding their increased depression and anxiety. Reviewed notes documented that R1 had recently seen the facility social worker, who documented that R1 continued to struggle with symptoms of depression and highlighted that R1 received psychiatric services from the local clinic. Notes also indicated that R1 had seen their psychiatrist on 3/4/2022 at 3/8/2022, who assessed R1 and adjusted R1’s medications accordingly.

Given the events that took place on 3/13/2022, the LPA observed a care note created on 3/15/2022 at 2:22 p.m. indicated that R1 was scheduled to speak to their psychiatrist on 3/16/2022 at 11:00 a.m. “if [R1] is willing to speak to [them]”. Per the note, it appears that staff had informed R1’s physician about the change of condition and scheduled an appointment, despite the claim that R1 may not speak to them at the time. The date and timing of the note was entered prior to the submission of this complaint to our department. Based on the information obtained in interviews and records review, there is insufficient evidence to support the claim that staff failed to inform R1’s physician of R1’s change of condition. Per the investigation, staff contacted both R1’s physician and psychiatrist about R1’s change of condition. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued to the Administrator.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023

LIC9099 (FAS) - (06/04)

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