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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801637
Report Date: 03/25/2021
Date Signed: 03/25/2021 04:40:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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-VENTURAFACILITY NUMBER:
565801637
ADMINISTRATOR:JULIAN BONDFACILITY TYPE:
740
ADDRESS:10900 TELEPHONE ROADTELEPHONE:
(805) 659-7515
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY:60CENSUS: 55DATE:
03/25/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Julian BondTIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) KaSandra Lopez conducted a Case Management Tele-Investigation inspection regarding a self reported incident. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s investigation began telephonically with Administrator Julian Bond at

On 09/18/2020, LPA Lopez began an investigation regarding a self-reported incident pertaining to Staff #1 (S1) and Resident #1 (R1). On 01/14/2020, R1 reported to facility staff that they were missing four (4) $2.00 bills from their room and suspected that S1 took the money. R1 reported they last saw the money in their room on 01/10/2020 and noticed it was missing 01/14/2020. R1 also reported about two (2) weeks prior to this, that S1 asked R1 for a loan of $20.00 due to not receiving their pay check in time as a result of the holiday (New Year’s Day); and, that S1 paid R1 back around 01/13/2020.

On 09/18/2020, at 9:00 AM and at 9:46 AM respectively, LPA Lopez conducted Zoom interviews with Resident #1 (R1) and Resident #2 (R2).

During the course of the investigation, LPA Lopez conducted additional interviews with six (6) residents and nine (9) staff, including S1; and, with Individual #1 and Individual #2. On 10/22/2020, telephonic interviews were conducted with Staff #2 (S2) at 1:07 PM and with Staff #3 (S3) at 1:19 PM. On 10/23/2020, a telephonic interview was conducted with Staff #4 (S4) at 1:06 PM. On 02/16/2021 at 10:41 AM, a telephonic interview was conducted with Staff #5 (S5). On 02/17/2021, LPA Lopez conducted telephonic interviews with Resident #3 (R3) at 9:29 AM, Resident #4 (R4) at 11:12 AM, Resident # 5 (R5) at 11:33 AM, and Resident #6 (R6) at 12:13 PM. On 02/18/2021, a telephonic interview was conducted with Resident #7 (R7) at 9:57 AM and Resident #8 (R8) at 1:15 PM.

Continued on LIC 809-C.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/25/2021
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 On 02/22/2021 at 1:00 PM, LPA Lopez conducted a virtual interview with S1. S1’s attorney was also present. On 02/24/2021 at 4:12 PM, the LPA conducted a telephonic interview with Staff #6 (S6). On 02/26/2021 at 1:03 PM, the LPA conducted a telephonic interview with Staff #7 (S7). On 03/01/2021, the LPA conducted a telephonic interview with Staff #8 (S8) at 11:56 AM and Staff #9 (S9) at 1:11 PM. On 03/17/2021, the LPA conducted a telephonic interview with Individual #1 (I1) at 9:01 AM and Individual #2 (I2) at 12:54 PM.

A review of facility records was conducted, including but not limited to, facility emails, staff schedules, S1’s personnel records and the 06/08/2020 CALVet Investigation Report. The LPA also obtained and reviewed the California Highway Patrol (CHP) Arrest-Investigation report on 03/17/2021. A copy of the Hearing Exhibits were also received and reviewed by the LPA. All these records were reviewed numerous times on various dates throughout the investigation.

During the interview with R1, they stated S1 asked to borrow $20.00 from R1 and then paid R1 back. R1 stated that around this time, R1 noticed five $2.00 bills were missing. They also noticed a bag of quarters were missing. During the interview with R2, R2 stated they gave S1 $20.00 to buy R2 honey, but never received the honey or the money back. R2 also stated in June 2019, while at the Chumash Casino, R2 offered S1 their gambling card to purchase a meal. When S1 was unable to use R2’s gambling card without R2 presence, R2 purchased S1 a meal which cost about $7.00 or $8.00. R2 also stated they gave S1, $100 in the past to purchase a toaster oven for the communal kitchen in the facility.

Interviews with S2, S3, S4, S5, S6, S7, S8, and S9, revealed no first-hand knowledge of S1 ever borrowing any money from any resident or any knowledge of S1 taking anything from any resident rooms. During the interview with S5, S5 stated they were in charge cleaning R1’s room, but S1 helped S5 clean R1’s room and cleaned R1’s room on S5’s days off.

Interviews with R4, R5, R6, R7, and R8 reported staff have never requested to borrow money from them or had any missing items in their room; or, suspected S1 of taking anything from their room. During the interview with R3, R3 suspected S1 took shampoo from R3’s room, but there was no proof to substantiate this statement.

Report continued on LIC 809-C.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/25/2021
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On 03/17/21 at 12:54 PM the LPA was advised by I2 that no other reports beyond the initial 01/17/2020 CHP Arrest-Investigation report were available.

During the interview with S1, S1 denied ever borrowing any money from R1 or taking any money from R1’s room. S1 denied ever accepting money to purchase honey for R2 and only talked about who could help R2 find honey. S1 also denied accepting any money or gifts from R2 while at the Chumash Casino. Regarding accepting money to purchase a toaster oven for R2, S1 denied ever accepting any money or purchasing the toaster oven and stated S1 only discussed how much a toaster oven would cost with R2.

A review of the staff schedule revealed that S1 was assigned to clean R1’s room on 01/12/2020 and 1/13/2020, and S5 was assigned to clean R1’s room on 01/10/2020, 01/11/2020, and 01/14/2020. Although, R1 reported money was missing from R1’s room on 01/14/2020, multiple staff, including housekeepers and caregivers have key access to R1’s room. During the Hearing Exhibit review, records reflect S1 had money in a bank account in their name around the time it is alleged S1 borrowed money from R1.

Based on the information obtained during the investigation, although the allegations may have occurred, there is insufficient evidence to support that S1 borrowed $20.00 from R1 or took any money from R1’s room. No citations are being issued at this time.

The findings were discussed with Mr. Bond during the initial call and again with Mr. Kevin Kielas and Mr. Bond at 4:05 PM.

A telephonic exit interview was conducted. A copy of the report and appeal rights were provided via email for signature.


SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021
LIC809 (FAS) - (06/04)
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