565801896-11-14-2024-29-AS-DPEA-DBCU8B-20241125142115

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801896
Report Date: 11/06/2024
Date Signed: 11/14/2024 09:26:44 AM

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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/04/2023 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20231204094008

FACILITY NAME:	LAND OF ENCHANTMENT BOARD AND CARE		FACILITY NUMBER:	565801896
ADMINISTRATOR:	ROXANA LARA		FACILITY TYPE:	740
ADDRESS:	346 E. GAINSBOROUGH ROAD		TELEPHONE:	(805) 379-2185
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	6	CENSUS: 6	DATE:	11/06/2024
		UNANNOUNCED	TIME BEGAN:	11:48 AM
MET WITH:	Roxana Lara		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility staff handled resident in a rough manner.
Facility staff did not note changes in resident's medical condition.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian conducted an unannounced subsequent complaint visit regarding allegations above. The LPA met with the Administrator and explained the reason for the visit.

On 12/04/2023, Community Care Licensing Division (CCLD) received a complaint with the above allegations. Investigation was initiated by LPA Campos on 12/08/2023. LPA Campos conducted a facility plant tour, interviewed residents at 11:08 a.m., 11:11 a.m., and 11:16 a.m., interviewed family at 11:24 a.m., interviewed staff at 12:05 p.m. and collected pertinent documents. A subsequent complaint visit was conducted on 01/09/2024 and additional interviews were conducted with staff at 1:37 p.m., administrator at 1:55 p.m. In addition, LPA Campos collected and reviewed pertinent documents at approximately 2:25 p.m.

On 11/06/2024 LPA Chochian conducted interview with other potiential witnesses at approximately 9:16am; reviewed additional records and interviewed potential witness between 10:30am - 11:40am. LPA Chochian also conducted interview with Administrator and reviewed records pertinent to this case. (Cont. to LIC9099c)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

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-20231204094008

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: LAND OF ENCHANTMENT BOARD AND CARE	FACILITY NUMBER: 565801896
	VISIT DATE: 11/06/2024

NARRATIVE

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Following is a summary of the investigation findings:

Regarding allegation, “Staff handled resident in a rough manner” – It was alleged that staff #1 is very rough when readjusting resident in wheelchair. Staff interviewed denied allegation. Staff reported that resident #1 (R1) was a two person assist and anytime staff would attempt to assist, R1 would get agitated and combative. According to staff they would let R1 calm down and would go back to assist and not force resident with anything. Staff recalled an incident (10/25/2023) where R1 slid down in the wheelchair and two staff readjusted R1. Staff expressed that residents are all handled with care and not in a rough manner. Three out of five residents were interviewed and did not report any staff mistreatment or rough handling. Potential witness interviewed did not report any rough handling or mistreatment by staff towards residents in care. R1 was transferred out and admitted to another facility on 11/30/2023 and passed away in 06/2024. Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the above allegation “Staff handled resident in a rough manner” is deemed UNSUBSTANTIATED at this time.

Regarding allegation, “Facility staff did not note changes in resident's medical condition” – Information was provided that R1 was moved to another facility on 11/30/2023 and R1 was observed with “several skin irritations on the verge of becoming bed sores”. It was alleged that staff did not note R1’s skin irritations. Review of R1’s facility records and daily notes on 12/04/2023 and 01/09/2024 did not reveal any skin irritation on the verge of becoming bed sores. Staff interviewed did confirm R1 had skin irritation however would get better over time and never developed into a wound/bedsore. Administrator and staff denied allegation and expressed that R1 did not have any bedsores to report as a medical condition. Potential witnesses interviewed could not confirm any neglect towards R1; confirmed small skin irritation to the back however none on the verge of becoming bedsores. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the above allegation “Facility staff did not note changes in resident's medical condition” is deemed UNSUBSTANTIATED at this time.

Exit interview conducted and a copy of report was provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

LIC9099 (FAS) - (06/04)

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