565801637-3-23-2021-29-AS-JAPL-C2HLBW-20210428083726

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801637
Report Date: 03/23/2021
Date Signed: 03/23/2021 04:58:21 PM

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
03/16/2021 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20210316135651

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:	03/23/2021
		UNANNOUNCED	TIME BEGAN:	01:09 PM
MET WITH:	Julian Bond		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Licensee failed to keep residents' information confidential from visitors and other residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted a Complaint Tele-Investigation inspection regarding the allegation listed above. 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 1:09 PM

At 1:09 PM the LPA began interviewing Administrator Julian Bond regarding the allegation. At 1:59 PM the LPA conducted a virtual inspection via face time with Mr. Bond. During this time, the LPA observed the staff office room, room 210 and the area surrounding the room. At 3:00 PM the LPA conducted a telephone interview with Resident #1 (R1).

The allegation of licensee failed to keep residents' information confidential from visitors and other residents alleges R1 and their visitors are able to hear confidential resident information as their bedroom is next to the staff office, of which confidential information is discussed. Report continued on LIC 9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2021

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-20210316135651

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: 03/23/2021

NARRATIVE

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During the interview with Mr. Bond, he stated around February 11, 2021 while in R1's room, he could hear staff talking in the office of which R1 shares a wall with. Mr. Bond stated he advised staff who were in the office at the time to remember to lower their voices and to keep the window closed when talking. Mr. Bond stated he also advised the RN supervisor of the issue and thought this would have mitigated the problem. Mr. Bond stated they are in the process of obtaining sound machines to help resolve the issue. Mr. Bond emailed the LPA information on the sound machines they plan on purchasing for the four medical work station. Mr. Bond also stated there have also been talks of changing resident rooms and relocating this resident to another room.

During the interview with R1, R1 stated while in their bedroom they have heard confidential resident information coming from the staff office and staff talking in general. R1 states they also have heard staff talking from the staff closet which is on the opposite side of their room. R1 said since Mr. Bond witnessed R1's ability to hear talking from the staff office, they have not heard staff talking as often, but it is still an issue.

Based on the information obtained, there is sufficient evidence to support the allegation of licensee failed to keep residents' information confidential from visitors and other residents. Therefore, the allegation is deemed substantiated. The following deficiency was observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties.

A telephonic exit interview was conducted with Mr. Bond at 4:32 PM and findings were explained. A copy of the report and appeal rights were provided via email for signature.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2021

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20210316135651

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/23/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/26/2021 Section Cited CCR 87468.1	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The administrator, Mr. Bond stated they would purchase sound machines to help mitigate the sound coming from the office. Mr. Bond stated they would also have a staff training on ensuring resident information is kept confidential. Proof of this shall be submitted to CCL by 3/26/21.
	8 9 10 11 12 13 14	Based on interviews obtained, the licensee did not comply with the section cited above as interviews with R1 and the administrator confirmed R1 was able to hear from their bedroom staff talking and confidential resident information from the staff office, which poses an immediate personal rights risk to residents in care.	8 9 10 11 12 13 14	Mr. Bond stated he will also look into relocating the resident to another bedroom but will implement the above measures in the meantime.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2021

LIC9099 (FAS) - (06/04)

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