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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802467
Report Date: 03/18/2022
Date Signed: 03/18/2022 07:57:51 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, THEFACILITY NUMBER:
565802467
ADMINISTRATOR:MCCAULEY, BRANDYFACILITY TYPE:
740
ADDRESS:111 N WELLS ROADTELEPHONE:
(805) 647-0616
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY:121CENSUS: 92DATE:
03/18/2022
UNANNOUNCEDTIME BEGAN:
12:41 PM
MET WITH:Brandy MccauleyTIME COMPLETED:
07:05 PM
ALLEGATION(S):
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Residents are not provided clean linens
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced subsequent complaint inspection at the facility today. The LPA met with Administrator Brandy McCauley at 12:41 PM and explained the reason for today's visit.
During the previous virtual inspection on 03/05/2021, an interview was conducted with the Administrator. At 1:43 PM a virtual inspection via FaceTime was conducted. Between 1:43 PM and 2:05 PM the LPA observed five residents rooms, rooms 124, 123, 103, 112, and 121.

During today's 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. The LPA also conducted interviews Resident #1 (R1) at 1:00 PM, and five staff between 1:51 PM and 4:00 PM. The LPA reviewed facility records beginning at 4:07 PM. At 5:07 PM, the LPA conducted an interview with the Administrator. Report continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
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-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: 03/18/2022
NARRATIVE
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The allegation of 'Residents are not being provided clean linen' alleges resident linens are dirty and stained. During today's inspection, and during the previous inspection, the LPA observed 13 resident rooms and observed clean, unstained linens and bedding in each room. Interviews with R1 and staff today, revealed no history of residents having soiled linens. Based on the information obtained, there is insufficient evidence to support the allegation occurred, therefore the allegation of 'Residents are not being provided clean linen' is deemed unsubstantiated at this time.

Exit interview and report reviewed with the Administrator. A copy of the report will be issued.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3