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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801637
Report Date: 12/02/2021
Date Signed: 12/02/2021 04:17:14 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
02/25/2021 and conducted by Evaluator Kasandra Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20210225161741
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: 57DATE:
12/02/2021
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Julian BondTIME COMPLETED:
01:55 PM
ALLEGATION(S):
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Staff sleeping during shift.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced subsequent complaint visit at the facility today regarding the above allegation. The complaint was initiated by LPA Lopez on 03/05/2021. Today the LPA met with at Administrator Julian Bond and Cindy Gambill, Hospital Administrative Representative II and explained the reason for today’s inspection.

During the initial 10-day virtual inspection on 03/05/2021, the LPA conducted a FaceTime interview with Administrator Julian Bond at 11:37 AM and conducted a virtual physical plant tour of the two (2) medication rooms and the workstations rooms in hallways C & D beginning at 11:49 AM. Pertinent documents were also emailed to the LPA.

The allegation of ‘Staff sleeping during shift’ alleged staff were sleeping while on duty during the night shift.
On 11/08/2021 and 11/29/2021, the LPA conducted telephone interviews with facility staff who work the overnight shift. Report continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 29-AS-20210225161741
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: 12/02/2021
NARRATIVE
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On 11/08/2021, 11/29/2021, and 12/01/2021, the LPA attempted to conduct telephone interviews with other relevant facility staff; however, was not successful. Moreover, during today’s inspection, the LPA conducted an interview with Staff #1 at 11:20 AM, and conducted a physical plant tour at 11:35 AM. The LPA also conducted interviews with five residents during the time period of 11:58 AM through 1:15 PM.

Interviews with the Administrator and the six staff revealed no reports of staff sleeping while on duty during the overnight shift. Interviews with residents revealed no issues or concerns regarding the overnight staff. Record review revealed four (4) LVNs, three (3) CNAs and two (2) Security Guards were scheduled to work overnight during February 2021 and March 2021.

Based on the information obtained, the department does not have sufficient evidence to support the allegation occurred. Therefore, the allegation is unsubstantiated at this time.

Exit interview conducted and report reviewed with the Administrator. A copy of the report and appeal rights will be emailed.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
LIC9099 (FAS) - (06/04)
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