565801810-10-28-2021-29-AS-NMAN-C8FQE2-20211104120536

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801810
Report Date: 10/28/2021
Date Signed: 10/28/2021 03:38:19 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
08/31/2020 and conducted by Evaluator Joann Rosales

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20200831140748

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:	10/28/2021
		UNANNOUNCED	TIME BEGAN:	02:19 PM
MET WITH:	Evan Granucci		TIME COMPLETED:	03:12 PM

ALLEGATION(S):

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Resident #1 (R1) developed a Stage 4 pressure Injury while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) JoAnn Rosales conducted a subsequent complaint investigation to deliver final investigation findings. LPA met with Administrator Evan Granucci.

It was alleged that on 08/28/2021 R1 was admitted to the hospital with sepsis and stage 4 pressure injury to the sacrum.

The allegation was investigated by Investigator Philippe Ryan Miles from the Investigations Branch (IB) of Community Care Licensing Division (CCLD). An investigation of the allegation involved interviews with the Administrator, facility staff and Home Health Care personnel as well as review of R1’s medical records. An Interview with the Home Health personnel on 11/5/2020 at approximately 3:19 pm revealed, R1 was receiving home health care and they provided wound care to R1 from 7/22/2020 to 8/13/2020. On 08/13/2020 R1’s home health care was interrupted. Interview with staff on 9/25/2020 at approximately 12:18 pm, 10/01/2020
Continued on 9099C

Substantiated

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: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

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 29-AS-20200831140748

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: 10/28/2021

NARRATIVE

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approximately 4:09 pm and on 11/6/2020 between 12:21 pm and 2:05 pm revealed that in July 2020, R1 presented a pressure injury on their lower back and on their heels. Staff indicated that after interruption of home health care services, from 08/13/2020 to 08/27/2020 the wound care was provided by the facility staff. During the week of 08/24/20, the pressure injuries progressively worsened. A pressure injury on R1’s lower back quickly opened up to a pea/dime size hole giving a foul smell. On 08/27/2020, during medical appointment, the dressing from R1’s pressure injury was removed a white/yellow puss that was deep the size of the pinky fingertip was observed along with a foul smell. R1 was sent to the hospital the following morning of 08/28/2020.

Home care records reviewed on 11/5/2020 revealed that on 07/22/2020 R1’s pressure injuries were assessed and documented. R1’s pressure injury on left hip was staged unstageable. A pressure injury on sacrum was staged a stage 4 and pressure injuries on left, and right heel were staged unstageable. R1’s hospital medical records reviewed on 10/13/2020 revealed that while in the hospital R1 presented with a stage 4 sacral decubitus ulcer that was later evaluated and diagnosed to be an infected unstageable sacral decubitus ulcer, that is fairly deep and appears to be clinically infected. Information revealed from the records is corroborating the information revealed from the interviews. Therefore, based on interviews and record review, the investigation the allegation is deemed substantiated at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

Today, a $500 immediate civil penalty (LIC 421 IM-Civil Penalty assessment) is assessed due to a violation which resulted in R1 sustaining an injury. The licensee was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f).

Exit interview was conducted, today's reports, civil penalty and appeals rights were 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: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20200831140748

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/28/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/29/2021 Section Cited CCR 87615(a)(1)	1 2 3 4 5 6 7	87615 Prohibited Health Conditions (a)(1) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator stated that they will provide documentation of scheduled staff training related to acceptance and/or retention of persons who have health condition not allowed to be admitted or retained in a residential care facility for the elderly to CCL by 10/29/21.
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee did not comply with the section cited above as R1 who was not on hospice developed a stage 4 pressure injury while residing in the facility which posed an immediate health risk to persons in care.	8 9 10 11 12 13 14
Type A 10/29/2021 Section Cited CCR 87466	1 2 3 4 5 6 7	87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning... When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator stated that they will provide documentation of scheduled staff training related to Observation of the Resident to CCL by 10/29/21. Administrator will provide documentation of training to CCL by 11/8/21.
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee did not comply with the section cited above as staff failed to communicate with R1's responsible person and physician regarding R1's change in condition which posed an immediate health and personal rights risk to persons in care.	8 9 10 11 12 13 14

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: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Joann Rosales	TELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

LIC9099 (FAS) - (06/04)

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