565802444-3-16-2023-29-AS-DPEA-CQBQ9X-20230327115904

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802444
Report Date: 03/16/2023
Date Signed: 03/16/2023 06:06:13 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
11/23/2022 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20221123141215

FACILITY NAME:	LAND OF ENCHANTMENT 1 BOARD AND CARE LLC		FACILITY NUMBER:	565802444
ADMINISTRATOR:	ROXANA LARA		FACILITY TYPE:	740
ADDRESS:	78 W GAINSBOROUGH RD		TELEPHONE:	(805) 601-5202
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	6	CENSUS:	DATE:	03/16/2023
		UNANNOUNCED	TIME BEGAN:	05:29 PM
MET WITH:	Roxana Lara		TIME COMPLETED:	06:10 PM

ALLEGATION(S):

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Staff did not assist resident with self-administered medications as prescribed

Resident not accorded dignity in relationships with staff.

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 11/29/2022 by LPA M. Arroyo. On today’s visit, LPA Arroyo met with Administrator, Roxana Lara. Entrance interview conducted.

During the initial visit on 11/29/2022, LPA Arroyo conducted a tour of the facility at 11:45 am, conducted interviews with the Administrator, three staff, four residents, and one hospice nurse between 11:50 am and 1:15 pm., and conducted a record review and obtained copies of census, resident records, and other pertinent documents relevant to the investigation at 12:10 pm. LPA Arroyo also conducted interviews with resident family members on 12/20/2022 at 2:08 pm and 2:53 pm.

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: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

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-20221123141215

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: LAND OF ENCHANTMENT 1 BOARD AND CARE LLC	FACILITY NUMBER: 565802444
	VISIT DATE: 03/16/2023

NARRATIVE

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Report continued from LIC 9099...

It was alleged that staff did not assist resident with self-administered medications as prescribed. It was reported that Resident #1 (R1) has an eye drops prescription that is to be administered three times a day, but staff was only administering to R1 twice a day. Record review of R1’s medication revealed R1 has a PRN for eye drops that is to be administered up to six (6) times a day. Interviews conducted with staff revealed eyes drops medication was being administered as needed per orders and not necessarily twice or three times a day. Furthermore, during an interview with R1’s family, R1’s family reported to LPA that R1 had stated staff was administering the eye drops medication as prescribed per instructions. Based on the information obtained during the course of the investigation, the Department does not have sufficient evidence to support the allegation of “staff did not assist resident with self-administered medications as prescribed”. Therefore, the allegation is deemed Unsubstantiated at this time.

It was also alleged that resident is not accorded dignity in relationships with staff. It was reported that staff are rude to R1 and interacting and speaking more to other residents. Interviews with the Administrator revealed staff is good at treating all residents the same and are always making sure everyone is getting taken care of. Interviews with staff revealed family members often visit the facility; and they have not reported the staff being rude to residents. Interviews conducted with residents revealed the facility is a great place and staff treats everyone like family. Additionally, residents interviewed did not report feeling disrespected or witness anyone else being disrespected by facility staff. Family members stated the staff has been respectful with both residents and visitors and added that they have nothing but good things to say about the facility and would definitely recommend. Furthermore, interviews with hospice nurse revealed they have observed staff interact with R1 and they are both wonderful and very attentive to R1. Based on interviews conducted with the Administrator, staff, residents, and family members, the Department does not have sufficient evidence to support the allegation of “resident not accorded dignity in relationships with staff”. Therefore, the allegation is deemed Unsubstantiated at this time.

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

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC9099 (FAS) - (06/04)

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