565802454-1-31-2023-29-AS-DPEA-CP45XS-20230215192112

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802454
Report Date: 01/31/2023
Date Signed: 01/31/2023 06:02:05 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
10/22/2020 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20201022082203

FACILITY NAME:	FOOTHILLS AT SIMI VALLEY, THE		FACILITY NUMBER:	565802454
ADMINISTRATOR:	BOGOYEVAC, LEATRICE		FACILITY TYPE:	740
ADDRESS:	5300 E LOS ANGELES AVENUE		TELEPHONE:	(805) 583-3500
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93063
CAPACITY:	175	CENSUS: 97	DATE:	01/31/2023
		UNANNOUNCED	TIME BEGAN:	05:00 PM
MET WITH:	Lea Bogoyevac, Administrator & Vanathda Dunn, Enliven Care Director		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Resident was sexually abused while in care
Facility staff failed to note change in resident's medical/dental condition
Facility staff are not attending to the residents' needs
Facility staff left residents in soaked diapers for extended periods of time

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit today to deliver final findings for the above allegations. The initial visit was conducted on 10/26/2020 by Licensing Program Analyst Kelly Dulek. Entrance interview conducted.

On 10/22/2020, the Department received an anonymous complaint alleging the following:

Resident #1 (R1) was sexually abused while in care. Information reported that R1 alleged being sexually assaulted by two (2) males at the facility (date/time unknown).

During the initial visit on 10/22/2020, former Administrator, Bill Boles, stated that no staff or resident of the facility reported any such incident. Staff and residents were interviewed on 10/26/2020 and 03/16/2022. Staff interviewed were not aware of any sexual incident happening in the facility. Residents interviewed on 3/16/2022, did not report any type of assault/mistreatment by staff.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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-20201022082203

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: FOOTHILLS AT SIMI VALLEY, THE	FACILITY NUMBER: 565802454
	VISIT DATE: 01/31/2023

NARRATIVE

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Based on limited information provided by the Reporting Party (RP) this allegation couldn’t be validated due to lack of sufficient evidence. Therefore, the above allegation “Resident was sexually abused while in care” is deemed UNSUBSTANTIATED at this time.

Additionally, it was alleged that facility staff failed to note change in resident's medical/dental condition and did not attend to the resident’s needs. Furthermore, it was also alleged that facility staff left residents in soaked diapers for extended periods of time. Per the Reporting Party (RP), Resident #2 (R2) was observed one morning (date/time unknown) with a thick white substance in R2’s mouth and staff did not observe resident throughout the night. It was also reported that during the COVID outbreak in the month of 10/2020, the facility did not take proper precautions in testing residents. It was further stated, Resident #3 (R3) was active and in good health but then came down with the "sniffles" and then was taken to a local hospital. It is alleged that upon R3 being discharged back to the facility, R3 appeared to only weigh about 80 pounds and had extensive black and blue bruising on left hip/pelvic area.

During the course of the investigation, on 10/26/2020 and 3/16/2022, LPA conducted interviews with facility staff, residents and potential witnesses. On 3/16/2022 and 1/20/2023, LPA gathered and reviewed documents. Records reviewed revealed R3 was hospitalized on 09/24/2020, following an unwitnessed fall and high fever. R3 was hospitalized for approximately ten (10) days and upon discharge was placed on a puree diet. Due to sudden decline in health, R3 was placed on hospice on 11/3/2020, and subsequently passed. On 10/26/2020 and 03/16/2022, LPA attempted to interview the responsible party of R3 but was not successful. Moreover, staff, residents and potential witnesses interviewed did not reveal any mistreatment or lack of care. Potential witness interviewed reported that they have not witnessed any resident be mistreated or left in soaked diapers for an extended time. Random residents interviewed reported feeling safe and denied any mistreatment or unmet needs.
Additionally, records reviewed noted that the facility’s first COVID case started in 9/2020, at which time the facility was in daily communication with Community Care Licensing (CCL) and Ventura County Public Health (VCPH). Per records reviewed, facility was following all guidelines and safety protocols given by public health during the outbreak. Based on information gathered and reviewed, the department does not have sufficient evidence to determine that the facility staff failed to note change in resident's medical/dental condition, staff did not attend to the resident’s needs and that the facility staff left residents in soaked diapers for extended periods of time. Therefore, the above allegations are deemed UNSUBSTANTIATED at this time. Exit interview conducted and copy of report provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC9099 (FAS) - (06/04)

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