565801810-6-25-2021-31-AS-NMAN-CEYW2D-20220601165404

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801810
Report Date: 06/25/2021
Date Signed: 06/25/2021 06:43:43 PM

Substantiated

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
06/18/2021 and conducted by Evaluator Joann Rosales

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20210618131726

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:	06/25/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Evan Granucci		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff are not elevating resident's legs as ordered by resident's doctor

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 staff were not elevating resident #1 (R1)'s legs as order by R1's doctor. A review of R1's records starting at 12:08 pm revealed that R1 has a physician's order on file to elevate their legs while sitting and 30 minutes after meals to place resident in bed as tolerated and elevate lower extremities. While conducting interviews LPA observed R1 sitting in a wheelchair with both legs not elevated in the community room. Interview with staff #1 (S1) starting at 1:27 pm revealed that R1 was not taken back to their room after lunch today and remained in the community room. Interview with S2 revealed that R1 was taken to the community room for lunch today around 11:30 am in their wheelchair and they had not observed R1's feet elevated after lunch today. Interview with S3 revealed that staff brought R1 to the community room
Continued on 9099C

Substantiated

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: 06/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2021

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-20210618131726

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: 06/25/2021

NARRATIVE

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around 11:20 or 11:30 am for lunch and R1 has been in the community room since then. S3 stated that they had not observed R1's feet elevated after lunch today. Interview with S4 revealed that they went to get R1 for lunch from their room around 11:30 am today and took R1 to the community room until approximately 1:50 pm when they took R1 back to their room to lay them down and elevate their feet. S4 stated that R1 remained in the community room without their feet being elevated. Based on the information obtained during the course of the investigation this allegation is deemed substantiated 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: 06/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 31-AS-20210618131726

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: 06/25/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/02/2021 Section Cited HSC 1569.269(a)(6)	1 2 3 4 5 6 7	1569.269 Enumerated rights; severability.(a)(6) Residents of residential care facilities for the elderly shall have all of the following rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are... qualifications, and competency to meet their needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator stated that they will provide documentation of staff training regarding regulation 1569.269 Enumerated rights; severability to CCL by 7/2/21.
	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 were not following R1's doctors order to elevate R1 feet which poses a potential health and personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Joann Rosales	TELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2021

LIC9099 (FAS) - (06/04)

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