565802467-4-21-2023-29-AS-JAPL-CSHM93-20230605092404

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802467
Report Date: 04/21/2023
Date Signed: 04/21/2023 09:32:01 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
10/06/2022 and conducted by Evaluator Teresa Camara

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20221006144842

FACILITY NAME:	PALMS AT BONAVENTURE ASSISTED LIVING, THE		FACILITY NUMBER:	565802467
ADMINISTRATOR:	MCCAULEY, BRANDY		FACILITY TYPE:	740
ADDRESS:	111 N WELLS ROAD		TELEPHONE:	(805) 647-0616
CITY:	VENTURA	STATE: CA	ZIP CODE:	93004
CAPACITY:	121	CENSUS: 92	DATE:	04/21/2023
		UNANNOUNCED	TIME BEGAN:	09:13 AM
MET WITH:	Brandy McCauley		TIME COMPLETED:	09:40 AM

ALLEGATION(S):

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Facility did not properly manage resident's personal belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent unannounced complaint visit regarding the above noted allegation. LPA met with Administrator/Executive Director Brandy McCauley, LVN and explained the reason for the visit.

On 10/6/2022, the Department received this complaint alleging the facility did not properly manage resident’s personal belongings. Specifically, the allegation was Resident 1 (R1) had a bracelet stolen from their room. LPA conducted an initial complaint visit on 10/13/2022, interviewed the administrator and reviewed records. R1’s records showed they declined to have their personal items inventoried upon admission. It was also reported R1 had private caregivers during the day who stayed with R1 in their room and took R1 on errands.

(continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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-20221006144842

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: PALMS AT BONAVENTURE ASSISTED LIVING, THE	FACILITY NUMBER: 565802467
	VISIT DATE: 04/21/2023

NARRATIVE

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(continued from 9099)

On 2/6/2023, LPA conducted another visit to the facility, met with the administrator and inspected R1’s vacant room. LPA learned that R1 had moved out of the facility. LPA then visited R1 at their new facility and spoke with one of R1’s private caregivers. LPA conducted telephone interviews with other private caregivers and R1’s responsible party.

On 2/6/2023 and 2/7/2023, LPA attempted to contact two additional potential witnesses (one former staff and one former agency staff), who were on schedule before and after the bracelet was missing but attempts were unsuccessful. LPA requested a copy of the police report, but a report was not available; there have been no arrests.

Based on information obtained during interviews, the Department cannot determine whether the bracelet was lost or stolen. Facility staff were not the only individuals with access to R1’s personal items as R1 also employed at least three different private caregivers. Therefore, the allegation that the facility did not properly manage resident's personal belongings is deemed Unsubstantiated at this time.

Exit interview conducted and a copy of the report was emailed to the administrator.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

LIC9099 (FAS) - (06/04)

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