565802433-7-15-2024-29-AS-DPEA-D7NVQY-20240730163906

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802433
Report Date: 07/15/2024
Date Signed: 07/15/2024 12:53:27 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
01/11/2024 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20240111143021

FACILITY NAME:	BELMONT VILLAGE THOUSAND OAKS		FACILITY NUMBER:	565802433
ADMINISTRATOR:	CYNTIA DRACHENBERG		FACILITY TYPE:	740
ADDRESS:	3680 N MOORPARK RD		TELEPHONE:	(805) 496-9301
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	158	CENSUS: 114	DATE:	07/15/2024
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Cyntia Drachenberg		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility is unsanitary.
Facility is malodorous.
Staff are not meeting residents' needs.
Staff do not follow safe sanitation practices.
Staff are not providing adequate supervision to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegations. The initial visit was conducted on 01/17/2024 by LPA K. Dulek, and a subsequent visit was conducted on 05/16/2024 by LPA M. Arroyo. On today's visit, LPA Arroyo met with Executive Director (ED), Cyntia Drachenberg. Entrance interview.

During the initial visit on 01/17/2024, LPA Dulek toured the facility at 10:39 a.m. and obtained copies of pertinent documents relevant to the investigation. On 05/16/2024, LPA Arroyo conducted a plant tour at 10:07 a.m. and observed random resident bedrooms in both Assisted Living and Memory Care unit, conducted interviews with six (6) staff members and eight (8) residents between 9:55 a.m. and 2:20 p.m., and obtained copies of pertinent documents.

Report 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: 07/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024

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-20240111143021

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: 07/15/2024

NARRATIVE

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Report Continued from LIC 9099...

It was alleged that the facility is unsanitary, and facility is malodorous. It was reported that the facility is dirty and smells bad. During the facility walkthroughs, LPAs observed multiple random resident bedrooms and common areas in both assisted living and memory care unit. There were no foul smells observed and facility appeared relatively clean. Record review of facility’s housekeeping operations manual includes daily common area cleaning checklist as well as weekly deep cleaning schedules for housekeeping personnel to follow. Interviews conducted with staff revealed that the common areas are cleaned at least once every day. Additionally, resident bedrooms are cleaned thoroughly once a week and maintained clean throughout the week by both the residents and care staff. Staff stated one of their first tasks every morning is to clean the common areas and pass by one more time before they leave for the day. Staff denied smelling any foul or bad odors in either the common areas or inside the residents’ bedrooms. Interviews conducted with family members revealed that facility is clean when they visit and did not report any bad odors while in the facility. Furthermore, interviews conducted with residents revealed that the facility is maintained cleaned by the staff and stated that they have not had any issues with foul smells and reported no concerns while living at the facility. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegations of “facility is unsanitary” and “facility is malodourous”. Therefore, these allegations are being deemed Unsubstantiated at this time.

It was also alleged that staff do not follow safe sanitation practices. It was reported that many residents were getting sick during the facility outbreak. Record review and Interviews conducted revealed that the facility had a Covid outbreak in December 2023. The positive cases were reported to both Ventura County Public Health (VCPH) and Community Care Licensing Department (CCLD). Additionally, staff stated they were following guidance from both VCPH and CCLD and testing was being conducted on all residents and staff. Furthermore, staff stated they update the facility’s infection control plan as needed and were making sure to follow accordingly.

Report Continued on LIC 9099C...

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240111143021

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: 07/15/2024

NARRATIVE

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Report Continued from LIC 9099C...

Record review of facility’s housekeeping training & operations manual revealed that facility has a response plan as well as disinfecting protocols for infectious diseases including norovirus and covid-19 which is expected to be followed by all staff. Staff added that common area are cleaned and disinfected every morning as well as before heading out for the day. Furthermore, interviews conducted with residents revealed that the facility is maintained clean by facility staff and stated they had no concerns while living at the facility. Based on record review and interviews conducted, the Department does not have sufficient evidence to support the allegation of “staff do not follow safe sanitation practices”. Therefore, this allegations is being deemed Unsubstantiated at this time.

It was further alleged that staff are not providing adequate supervision to residents and staff are not meeting the residents’ needs. It was reported that residents sit for hours with long strings of snot hanging out of their noses. Interviews conducted with staff revealed that they have not had any staffing concerns as they have been fully staffed. Additionally, staff stated that they walk through the common areas during the day when not assisting residents to make sure the residents are okay. As far as the residents that prefer to stay in their bedrooms, staff conduct status checks throughout the day to make sure they are fine, and their needs are being met. Interviews conducted with family members revealed that there is always staff nearby whenever they visit the facility. Family members stated that they felt facility staff provide the supervision the residents need and added that facility staff are taking good care of the residents as well. Interviews conducted with residents revealed that facility staff assist whenever resident call for them and have not reported any issues with staff not being able to assist when needed. Residents also stated that staff come by their bedrooms to check on them and make sure they are doing fine a few times throughout the day. Furthermore, residents and their family members have not reported any concerns with facility not having enough staff to meet the residents needs and displayed no concerns with facility staff. Based on the information obtained during the investigation, the Department does not have sufficient evidence to support the allegations of “staff are not providing adequate supervision to residents” and “staff are not meeting the residents’ needs”. Therefore, these allegations are being deemed Unsubstantiated at this time.

Exit interview. Copy of the report was issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024

LIC9099 (FAS) - (06/04)

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