565801810-7-28-2021-31-AS-TAGD-D5NLEB-20240527084113

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801810
Report Date: 07/28/2021
Date Signed: 07/28/2021 07:00:27 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/21/2021 and conducted by Evaluator Joann Rosales

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20210721160917

FACILITY NAME:	VENTURA TOWNEHOUSE		FACILITY NUMBER:	565801810
ADMINISTRATOR:	EVAN GRANUCCI		FACILITY TYPE:	740
ADDRESS:	4900 TELEGRAPH ROAD		TELEPHONE:	(805) 642-3263
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	566	CENSUS: 214	DATE:	07/28/2021
		UNANNOUNCED	TIME BEGAN:	10:52 AM
MET WITH:	Evan Granucci		TIME COMPLETED:	06:11 PM

ALLEGATION(S):

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Facility did not follow COVID-19 mitigation plan
Facility is not in good repair

INVESTIGATION FINDINGS:

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During today's visit Licensing Program Analyst (LPA) JoAnn Rosales toured the facility with Administrator and staff Joseph Messina, reviewed random resident records, interviewed random staff and residents and obtained copies of pertinent documents.

Concerns were that that facility did not follow COVID-19 mitigation plan as staff were not being notified of positive COVID-19 residents and staff were not being provided gloves. Interview with staff #2 (S2), S3, S4, S5, S6, S7, S8, S9 and S10 starting at 1:49 pm revealed that they received notification of COVID-19 positive residents in the facility from their Manager as well as other facility staff. Staff also stated that they always had access to gloves. Concerns were that the facility was not in good repair as R1's sink and toilet had black stuff coming out of it. Interview with R1 at 1:27 pm revealed that just this morning they had a little bit of black stuff come out of the bathtub drain however, they did not report it to anyone as it was minimal. R1 stated that this is the first time this happened and they have not had any black stuff come out of their sink or toilet. Interview
Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Joann Rosales	TELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

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 31-AS-20210721160917

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: VENTURA TOWNEHOUSE	FACILITY NUMBER: 565801810
	VISIT DATE: 07/28/2021

NARRATIVE

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with S1 at 1:18 pm revealed that they were not aware of R1 having any plumbing issues and they have not had any work orders for R1's room. S1 stated that they will be looking at R1's bathtub drain today. At 1:24 pm LPA and S1 observed black stuff in R1's bathtub. LPA and S1 did not observe any black stuff coming out of R1's sink or toilet. Based on the information obtained during the course of the investigation the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Today's reports and appeal rights were reviewed and emailed to Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Joann Rosales	TELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

LIC9099 (FAS) - (06/04)

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