565802467-5-7-2025-29-AS-KBUY-DJ62W6-20250630174501

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802467
Report Date: 05/07/2025
Date Signed: 05/07/2025 04:50:03 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
12/30/2024 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20241230101400

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: 102	DATE:	05/07/2025
		UNANNOUNCED	TIME BEGAN:	11:19 AM
MET WITH:	Brandy McCauley		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff are not following protocol for communicable disease.
Staff did not provide adequate food service to resident.
Staff did not ensure resident's room is free of pest.
Staff did not treat resident with dignity.
Staff did not safeguard resident's personal belongings.
Staff did not respond to resident's calls for assistance in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit. LPA met with Administrator Brandy McCauley and explained the reason for the visit.

On 1/8/2025, LPA reviewed and obtained documents and interviewed three staff. During today's visit LPA interviewed ten (10) residents and three (3) more staff.

Regarding the allegation staff are not following protocol for communicable disease:
Residents who were interviewed that were present at the facility during a COVID outbreak stated residents were offered masks, all staff wore masks and gloves, and their cleaning protocols seemed sufficient. Staff stated they were given refresher training, and wore masks and gloves. The staff stated they would wear N95 masks, gowns,

(continued on LIC9099-C, page 2)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

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-20241230101400

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PALMS AT BONAVENTURE ASSISTED LIVING, THE	FACILITY NUMBER: 565802467
	VISIT DATE: 05/07/2025

NARRATIVE

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(continued from LIC9099, page 1)

and gloves when providing care to those residents who tested positive. Staff stated when there is an outbreak at the facility masks are located at the front desk for residents and visitors. They notify everyone who signs in there is an outbreak. The staff stated they encourage residents who are sick and need to leave their room to wear a mask when leaving their room. Based on this information, this allegation is deemed Unsubstantiated at this time.

Regarding the allegation staff did not provide adequate food service to resident:
Residents who were interviewed that were present at the facility during a COVID outbreak stated residents were not allowed to eat in the dining room and were provided room service. Most of the residents stated the food was the same as when they eat in the dining room and they did not notice issues with the quality or temperature of the food. There were a couple residents who stated their food was cold so they either heated it up in the microwave in their room or asked staff for assistance. Residents stated for the most part they enjoy the food that is offered at the facility. Based on this information, the allegation is deemed Unsubstantiated at this time.

Regarding the allegation staff did not ensure resident's room is free of pests:
Out of the ten (10) residents interviewed, three (3) residents stated they had ants in their bathroom from time to time. They would tell staff and the staff would take care of it. The administrator stated the facility has a contract with an exterminator. Sometimes their maintenance director will spray inside the facility and other times the exterminator will take care of it. Based on this information, the allegation is deemed Unsubstantiated at this time.

Regarding the allegation staff did not treat resident with dignity:
Out of the ten (10) residents interviewed, one (1) complained of staff who did not treat them respectfully. The resident stated the dining room staff could be rude sometimes but the caregivers were always respectful. The other residents stated all staff were respectful. The staff interviewed stated resident 1 (R1) did not want to be at the facility. R1's only wish was to return home. R1 worked with therapists and was able to move home within a couple months. Caregivers who worked with R1 stated R1 was kind, sweet and funny. The caregivers and management were unaware of R1 having any issues with how they treated R1. Based on this information, the allegation is deemed Unsubstantiated at this time.

(continued on LIC9099-C, page 3)

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20241230101400

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PALMS AT BONAVENTURE ASSISTED LIVING, THE	FACILITY NUMBER: 565802467
	VISIT DATE: 05/07/2025

NARRATIVE

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(continued from LIC9099-C, page 2)

Regarding the allegation staff did not safeguard resident's personal belongings:
This allegation was specifically regarding R1 missing their wallet. It was reported to the facility by R1's friend. R1 left the wallet on the TV stand and stated when they returned to their room the wallet was missing. On 12/8/2024, R1' s friend reported the missing wallet to facility management who searched for the wallet but did not locate it. The Ventura Police Department (VPD) was called and they took a report on 12/10/2024. VPD did not investigate this incident. R1 cancelled credit cards and there were no known fraudulent charges. Out of the ten (10) residents interviewed, one (1) stated their AirPods were missing and staff helped them locate them using the built-in tracking system. They were found to be at the facility's contracted nail technician's house. The nail technician returned the AirPods and stated they were found in the parking lot and she intended to bring them back the next time she was at the facility. That nail technician is no longer contracted to work at the facility. The nail technician was a third-party contractor and not an employee of the facility's. Based on this information, the allegation is deemed Unsubstantiated at this time.

Regarding the allegation staff did not respond to resident's calls for assistance in a timely manner:
This allegation was specifically regarding R1 being left on the floor for an extended period after R1 had slipped off the couch. LPA obtained the pendant call record for the date of this incident (12/14/2024) which shows R1 used the pendant five (5) times that day with wait times as follows: three (3) minutes on three (3) calls, eight (8) minutes on one call, and nine (9) minutes on one call. The facility's guidelines for response times is a maximum of 15 minutes. The residents LPA interviewed stated they did not have to wait very long for their pendant calls to be answered with one resident stating their maximum wait time is approximately ten (10) minutes. The caregivers stated they try to respond to pendant calls immediately but if they are actively assisting other residents then the wait time may be longer than a few minutes but not usually more than ten (10) minutes. Based on this information, the allegation is deemed Unsubstantiated at this time.

No deficiencies were observed. Exit interview conducted and report issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

LIC9099 (FAS) - (06/04)

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