565802416-10-30-2024-29-AS-KHEN-DAKQQN-20241031122238

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802416
Report Date: 10/30/2024
Date Signed: 10/30/2024 02:57:14 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
05/15/2024 and conducted by Evaluator Kelly Dulek

COMPLAINT CONTROL NUMBER: 29-AS-20240515140759

FACILITY NAME:	VILLA TERESA RESIDENTIAL CARE		FACILITY NUMBER:	565802416
ADMINISTRATOR:	MARILOU ROJAS		FACILITY TYPE:	740
ADDRESS:	821 TERESA STREET		TELEPHONE:	(805) 604-7772
CITY:	OXNARD	STATE: CA	ZIP CODE:	93030
CAPACITY:	6	CENSUS: 5	DATE:	10/30/2024
		UNANNOUNCED	TIME BEGAN:	02:21 PM
MET WITH:	George Yazbek, Licensee		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Licensee is not providing comfortable accommodations
Facility staff is unable to meet resident's needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted an unnanounced subsequent complaint visit to the facility with the purpose of delivering findings for the above allegations. LPA initially met with facility staff Emerson del Monte. Licensee George Yazbek was contacted via telephone and arrived at the facility at 02:43PM. Entrance interview conducted.

During today's visit, LPA briefly toured the facility at 02:25PM and observed the residents. LPA also interviewed staff and reviewed Resident #1 (R1)’s file at 02:27PM. During an initial complaint visit conducted on 05/16/2024, LPA interviewed Administrator and Assistant Administrator at 12:40PM, conducted a physical plant tour at 12:47PM, reviewed resident files and took photographs of pertinent documents, and interviewed residents and staff from 01:17PM to 02:15PM. The following was then determined:

Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

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-20240515140759

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: VILLA TERESA RESIDENTIAL CARE	FACILITY NUMBER: 565802416
	VISIT DATE: 10/30/2024

NARRATIVE

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The complaint alleges that facility staff cannot meet R1’s needs, as R1 is awake and screaming all day and night, which then makes an uncomfortable environment for other residents in care. During the initial visit, LPA interviewed residents and staff. Additionally, LPA observed R1 and attempted to interview R1. R1 stated their room is nice and quiet and R1 enjoys spending about half their time in the common spaces of the facility and the other half in their room. During the interview, R1 was pleasant, but tired, so staff brought R1 to their room to rest. LPA did not hear any noise from R1’s bedroom throughout either the initial or subsequent visit. Other residents interviewed indicated they have not heard any screaming at night or during the day. Residents stated the facility is calm and quiet. Staff interviewed indicated that R1 did yell on Tuesday 05/14/2024 in the early morning hours upon waking at about 06:00 or 06:30AM. Interview revealed that R1 awoke asking for their son, after their son visited for Mother’s Day. Staff did calm R1 and tend to R1’s needs. On that day, they were able to call R1’s son on the phone to allow for a telephone visit. Staff interviewed indicated this has only ever happened “once in a blue moon” and R1 has been residing at the facility without issue since 2021. Staff were aware another resident in the facility is unhappy that R1 did yell that one morning, so staff had been communicating with R1’s family, as well as the family of a different resident in an attempt to move R1’s room farther away from the other resident. At the time of the initial visit, the move was pending. LPA confirmed during the subsequent visit that R1 had been relocated to another room. All residents interviewed indicated the facility is comfortable, their needs are met and that the staff are great.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted. A copy of today’s report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC9099 (FAS) - (06/04)

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