565802433-5-16-2024-29-AS-DPEA-D5PPF9-20240528111622

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802433
Report Date: 05/16/2024
Date Signed: 05/16/2024 03:34:58 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
06/19/2023 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20230619081431

FACILITY NAME:	BELMONT VILLAGE THOUSAND OAKS		FACILITY NUMBER:	565802433
ADMINISTRATOR:	NANCY D NELSON		FACILITY TYPE:	740
ADDRESS:	3680 N MOORPARK RD		TELEPHONE:	(805) 496-9301
CITY:	THOUSAND OAKS	STATE:	ZIP CODE:	91360
CAPACITY:	158	CENSUS: 112	DATE:	05/16/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Cyntia Drachenberg		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Facility is trying to persuade resident and/or their responsibly parties to change physicians or home health agency to one’s preferred by administration.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Martha Arroyo conducted an unannounced subsequent complaint investigation for the above allegation. Upon arrival, LPA met with Executive Director (ED), Cyntia Drachenberg and explained the reason for the visit. Entrance interview.

During the initial visit on 06/23/2023, LPA Campos conducted interviews with the ED and Director of Resident Services and obtained resident records and other pertinent documents relevant to the investigation. On today’s visit, LPA Arroyo conducted a plant tour at 10:07 a.m., conducted interviews with two (2) staff members, one (1) resident, and two (2) family members between 9:55 a.m. and 1:10 p.m., and obtained copies of pertinent documents.

Continued on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

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-20230619081431

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: BELMONT VILLAGE THOUSAND OAKS	FACILITY NUMBER: 565802433
	VISIT DATE: 05/16/2024

NARRATIVE

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Continued from LIC 9099...

It was alleged that facility is trying to persuade resident and/or their responsibly parties to change physicians or home health agency to one’s preferred by administration. It was reported that certain home health companies and physicians are self-referring clients for money and having facilities change the resident’s Primary Care Physician (PCP). Interviews conducted with staff revealed that many residents that are admitted to the facility have come from other neighboring facilities. These residents when admitted to the facility already have a PCP which they utilize. Additionally, staff added that sometimes family members may ask for a local doctor to establish care for their family member when the resident is hard to ambulate or be taken out of the facility. In which, the facility provides a list with different doctors in the area and a contact number. However, it is ultimately the family’s choice as they call themselves to get more information and decide between what the insurance covers and which provider can meet the needs of the resident. Interviews with staff further revealed that residents discharged from the hospital already come with a home health agency that their doctors recommended. If a resident requires any service from a home health agency, the facility contacts the resident’s PCP, and they will assign whichever home health agency they use or is covered by their insurance. Interviews conducted with family members revealed that they have not felt pushed or forced to select a certain doctor or home health agency by the facility. Family members stated that the resident’s doctor has not changed in years and added that it would not change even if the facility suggested it. Interview conducted with resident revealed that changing doctors was a decision made only by themselves and no one else. Furthermore, resident denied the facility persuaded them to making that change at any time while living at the facility. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “facility is trying to persuade resident and/or their responsibly parties to change physicians or home health agency to one’s preferred by administration”. Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued. Report was reviewed and a copy was issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC9099 (FAS) - (06/04)

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