565801810-9-10-2021-29-AS-NGID-C73VWD-20210921164745

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801810
Report Date: 09/10/2021
Date Signed: 09/10/2021 02:53:23 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/28/2020 and conducted by Evaluator Joann Rosales

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20200928140550

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: 210	DATE:	09/10/2021
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Evan Granucci		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Questionable death

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) JoAnn Rosales conducted a subsequent complaint investigation to deliver the final findings for the above allegation.

On 09/28/2020 the Department received a complaint regarding the allegation of a questionable death of Resident #1 (R1) due to neglect/lack of care and supervision. R1 died on 08/16/2020 from septic shock due to a urinary tract infection (UTI). The complaint was referred to Community Care Licensing Investigations Branch and assigned to Investigator Philippe Ryan Miles.

On 10/01/2020 at 12:26 p.m. LPA JoAnn Rosales virtually conducted the initial complaint visit to request copies of pertinent documents relevant to the investigation.

Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Joann Rosales	TELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021

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-20200928140550

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: 09/10/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Investigator Miles conducted interviews with R1’s relative on 10/30/2020 at approximately 1240 hours, caregivers on 11/06/2020 at approximately 1221 hours to approximately 1405 hours, Licensed Vocational Nurse (LVN) and Memory Care Director on 11/24/2020 at approximately 1200 hours, R1’s Primary Physician on 11/25/2020 at approximately 1147 hours, and Director of Health and Wellness on 12/10/2020 at approximately 1100 hours.

Community Memorial Hospital Medical records for R1 were reviewed on 10/29/2020. Information contained in the records revealed that on 08/07/2020 R1 was found to be lethargic and hypotensive. R1 was admitted to the Intensive Care Unit (ICU) with sepsis and/or septic shock, lactic acidosis, and urinary tract infection (UTI). R1’s urine appeared grossly purulent; also known as, pyuria and UTI “is most likely” the cause of the sepsis. Medical records did not state the duration of the UTI present in R1’s body. R1 expired in the morning on 08/16/2020.

Based on R1's physician’s professional medical opinion, due to R1’s severe dementia, on-going health conditions/issues, and age were factors that would not allow R1 to verbalize any type of pain or sensation in the urethra. Since R1 was incontinent and wore diapers, R1 was more susceptible to UTIs at any given time. The physician stated without a proper urine analysis/test, it would have been hard to determine the presence of a UTI.

The caregivers interviewed did not observe any signs of a UTI present in the diaper; nor did they observe anything unusual with R1’s urine or stool throughout the week of 08/03/2020 to 08/07/2020.

Based on the information and documentation provided, there is not enough evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview was conducted, today's report was reviewed and emailed to the Administrator.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Joann Rosales	TELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2