565801963-2-15-2023-29-AS-DPEA-CPCRWQ-20230224122327

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801963
Report Date: 02/15/2023
Date Signed: 02/15/2023 02:23:23 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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/29/2021 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20210429113833

FACILITY NAME:	CAMARILLO SENIOR LIVING		FACILITY NUMBER:	565801963
ADMINISTRATOR:	GONZAGA, VINCENT		FACILITY TYPE:	741
ADDRESS:	6000 SANTA ROSA RD		TELEPHONE:	(805) 388-8086
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93012
CAPACITY:	0	CENSUS:	DATE:	02/15/2023
		UNANNOUNCED	TIME BEGAN:	02:07 PM
MET WITH:			TIME COMPLETED:	02:08 PM

ALLEGATION(S):

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Facility does not have sufficient staff to meet the needs of the resident.
Facility staff is not qualified.

INVESTIGATION FINDINGS:

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On 02/15/2023, Licensing Program Analyst (LPA) KaSandra Lopez attempted to deliver the complaint findings regarding the above complaint allegations to Jeffrey Bradshaw, CEO of Management Company ACSR, LLC for Licensee S-H OPCO CAMARILLO LLC, but the LPA was only able to leave a message. The facility under this licensee closed effective 07/26/2021. A copy of this report will be mailed to the former licensee of the facility for signature.

On 04/29/2021, Community Care Licensing received the complaint and a complaint investigation was initiated on 05/07/2021. LPA Lopez met with Administrator, at the time, Vincent Gonzaga, and Health and Wellness Director, at the time, Jowell Ovenson and explained the reason for the inspection. During the inspection the LPA conducted interviews with the Health and Wellness Director and with Resident #1 (R1) between 3:23 PM and 4:35 PM. The LPA reviewed facility records and obtained pertinent copies.
Report continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

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-20210429113833

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: CAMARILLO SENIOR LIVING	FACILITY NUMBER: 565801963
	VISIT DATE: 02/15/2023

NARRATIVE

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The allegation of ‘Facility does not have sufficient staff to meet the needs of the resident’ alleges staff are overworked, spread too thin, and R1 must wait long periods of time for assistance. During the interview with R1, they stated they only receive two hours of care a day out of 24 hours and there are not enough caregivers for the number of residents. During the investigation, the LPA requested pendent call records for R1, but they were not available. During the interview with the Health and Wellness Director, they state R1 would talk a lot and complain a lot and would keep staff in their room which was a challenge for staff to complete their other duties. The LPA attempted to interview additional staff working at the time the complaint was filed but there were not any available. Based on interviews and information received during the investigation there is insufficient evidence to support the allegation of 'Facility does not have sufficient staff to meet the needs of the resident'. Therefore, the allegation is deemed unsubstantiated.

The allegation of ‘Facility staff is not qualified’ alleges all staff are not properly trained to assist R1 with their compression stockings. During the interview with R1, they stated not all staff knew how to help R1 put on their stockings the right way and when this happens, they need to call another staff to assist. During the interview with S1, who is a medical professional, they stated staff did not need special training to assist R1 with their compression stockings and stated the stockings are wrapped on the leg like ace bandages. The LPA attempted to interview additional staff working at the time the complaint was filed but there were not any available. Based on the information on obtained there is insufficient evidence to support the allegation of ‘Facility staff is not qualified’ occurred. Therefore, the allegation is deemed unsubstantiated at this time.

Report and appeal rights were mailed to the licensee's mailing address for signature.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

LIC9099 (FAS) - (06/04)

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