565802441-4-26-2023-29-AS-JAPL-CRBSMX-20230428140040

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802441
Report Date: 04/26/2023
Date Signed: 04/26/2023 11:52:26 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
03/29/2023 and conducted by Evaluator Elsie Campos

COMPLAINT CONTROL NUMBER: 29-AS-20230329111941

FACILITY NAME:	LOVELY COMMUNITY HEALTHCARE		FACILITY NUMBER:	565802441
ADMINISTRATOR:	TOUME, CILVA		FACILITY TYPE:	740
ADDRESS:	52 W NORMAN AVENUE		TELEPHONE:	(805) 852-8770
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	6	CENSUS: 6	DATE:	04/26/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Maria Jesusa Esmejarda "Suzette"		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff slapped resident
Staff sexually harassed resident
Resident not being fed meals

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elsie Campos arrived unannounced for a subsequent complaint visit to deliver the findings for the above allegations.

The LPA met with Staff at 10:45 a.m., Administrator Cilva Toume was unable toarrice at the facility and gave permission for staff to sign the report. The LPA explained the reason for the visit.

During the visit on 4/6/2023, the LPA toured the facility at 10:30 a.m., collected pertinent documents at 10:40 a.m., interviewed staff at 10:50 a.m.,10:57 a.m., and 11:21 a.m., interviewed residents at 11:04 a.m., 11:08 a.m., 11:10 a.m., 11:16 a.m., and 11:17 a.m. Attempted interviews with witnesses at 12:58 p.m. and 1:38 p.m. During today’s visit, the LPA toured the facility at 10:55 a.m. to ensure that there were no immediate health and safety concerns and delivered the findings.
***Continued on LIC9099-C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 29-AS-20230329111941

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: LOVELY COMMUNITY HEALTHCARE	FACILITY NUMBER: 565802441
	VISIT DATE: 04/26/2023

NARRATIVE

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Regarding the allegation: Staff slapped resident
It was alleged that staff slapped resident #1 (R1). An interview with R1 denied claims that staff at Lovely Community Healthcare ever physically abused them or slapped them. Staff denied all claims that they had slapped R1 while providing care. Staff said that although R1 would present behavioral difficulties such as resistance to cleaning their room or keeping it organized, they never slapped R1. Staff further claimed that if R1 needed anything or asked for something they would comply. R1’s physician stated that they did not know if the concern addressed was in regard to this facility or a previous facility at which R1 resided for a number of years. R1’s physician stated that due to past experiences and trauma they believed that R1’s claims have the potential to lack validity in relation to the claims being brought against this facility. R1 claimed that they had not had negative interactions with the facility staff other than a personal disagreement with the Administrator related to insurance. Residents claimed that staff had appropriate relationships with the residents and denied claims that staff had ever been physically abusive. Residents did not have any negative things to say about the staff. Based on the information obtained, there is insufficient evidence to support the claim that staff slaps residents. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff sexually harassed resident
It was alleged that staff sexually harassed resident #1(R1). An interview with R1 denied claims that staff at Lovely Community Healthcare have ever made any sexual advances, made sexual remarks, or ever touched them in appropriately. Staff denied all claims that they have sexually harassed any resident. Staff said that although R1 would present behavioral difficulties such as resistance to cleaning their room or keeping it organized, they were never talked to inappropriately or sexually harassed. R1’s physician stated that they did not know if the concern addressed was in regard to this facility or a previous facility at which R1 resided for a number of years. R1’s physician stated that due to past experiences and trauma they believed that R1’s claims have the potential to lack validity in relation to the claims being brought against this facility. R1 claimed that they had not had negative interactions with the facility staff other than a personal disagreement with the Administrator related to insurance and that staff had never harassed them in any way. Residents claimed that staff had appropriate relationships with the residents and denied claims that staff had ever been inappropriate with them. Residents did not have any negative things to say about the staff. Based on the information obtained, there is insufficient evidence to support the claim that staff sexually harassed resident. This allegation is deemed Unsubstantiated at this time.
***Continued on LIC 9099-C***

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20230329111941

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: LOVELY COMMUNITY HEALTHCARE	FACILITY NUMBER: 565802441
	VISIT DATE: 04/26/2023

NARRATIVE

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Regarding the allegation: Resident not being fed meals
It was alleged that staff was not feeding meals to resident #1(R1). An interview with R1 denied claims that staff at Lovely Community Healthcare have left them without a meal. Staff denied all claims that they have ever not fed a resident in care. Staff said that when residents are resistant to eat at meal times that they ensure that there is a meal available to them at any time. Additionally, LPA observed on multiple occasions that staff were preparing meals at various times of the day and observed resident’s eating either in their room or at the dining room table. R1’s physician stated that they did not know if the concern addressed was in regard to this facility or a previous facility at which R1 resided for a number of years. R1’s physician stated that due to past experiences and trauma they believed that R1’s claims have the potential to lack validity in relation to the claims being brought against this facility. R1 claimed that they had not had negative interactions with the facility staff other than a personal disagreement with the Administrator related to insurance and that they loved how staff cooked meals. Residents claimed that staff cooked wonderfully and denied claims that staff had ever left them without food. Residents did not have any negative things to say about the staff. Based on the information obtained, there is insufficient evidence to support the claim that resident is not being fed meals. This allegation is deemed Unsubstantiated at this time.

No immediate health and safety concerns observed during today's visit. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC9099 (FAS) - (06/04)

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