565802467-2-17-2023-29-AS-DPEA-CQ8TNP-20230324145305

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802467
Report Date: 02/17/2023
Date Signed: 02/17/2023 03:21:01 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
02/26/2021 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20210226084535

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: 91	DATE:	02/17/2023
		UNANNOUNCED	TIME BEGAN:	10:42 AM
MET WITH:	Brandy McCauley		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Staff are taking call pendents away from residents
Staff not meeting residents incontinence needs
Meals do not consist of an appropriate variety of foods

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced subsequent complaint inspection regarding the above allegations. The LPA met with Administrator Brandy McCauley at 10:45 AM and explained the reason for the inspection.

On 03/05/2021, the complaint investigation began, although due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures the inspection was conducted virtually with the Administrator. During the visit, between 1:43 PM and 2:05 PM the LPA observed five residents rooms, rooms 124, 123, 103, 112, and 121 and the LPA requested pertinent records to be emailed.
On 03/18/2022, the LPA conducted an in person inspection at the facility. During the inspection, the LPA conducted a physical plant tour with the Administrator beginning at 12:46 PM. Between 12:46 PM and 1:45 PM, the LPA observed four resident rooms in Assisted Living and four resident rooms in Memory Care. Report continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

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-20210226084535

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: 02/17/2023

NARRATIVE

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The LPA conducted interviews with Resident #1 (R1) at 1:00 PM, and five staff between 1:51 PM and 4:00 PM. The LPA also reviewed facility records and the kitchen menu beginning at 4:07 PM. At 5:07 PM, the LPA conducted an interview with the Administrator

During today's inspection, the LPA observed the physical plant briefly and conducted interviews with seven residents and two staff members between 10:55 AM and 12:39 PM. The LPA also reviewed facility records, including the facility menu and Monthly Consultant Dietician Report.

The allegation of 'Staff are taking call pendents away from residents' alleges staff were taking the pendents of resident who call for assistance too often. Interviews with residents during today's visit and during the prior visit revealed no complaints of staff taking their pendent for being used too often. Interviews with staff also revealed no knowledge of staff taking resident pendents due to excessive use. Based on the information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of 'Staff are taking call pendents away from residents' is deemed unsubstantiated at this time.

The allegation of 'Staff not meeting residents incontinence needs' alleges staff are leaving residents in soiled diapers for a long period of time. Interviews with staff during today's inspection and during the prior inspection, revealed residents are changed at least four times a shift or as often as needed and no reports of residents being left soiled routinely from the prior shift. Interviews with residents revealed no concerns regarding staff and their assistance with activities of daily living. Based on this information, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of 'Staff leave residents in soiled diapers for a long period of time' is deemed unsubstantiated at this time.

The allegation of 'Meals do not consist of an appropriate variety of foods' alleges residents are served the same thing and do not receive enough variety of foods. The LPA reviewed the facility menu for the week of March 13th 2021, and for the months of January and February 2023. The LPA observed a variety of food being served each week. Menus are also reviewed by the Consultant Dietician monthly with the last report being in January 2023. Interviews with residents revealed no major issues or concerns with food and resident were generally satisfied with the menu and variety. Based on the information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of 'Meals do not consist of an appropriate variety of foods' is deemed unsubstantiated at this time. Exit interview and report reviewed. A copy of the report and appeal rights provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

LIC9099 (FAS) - (06/04)

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