565802467-2-17-2023-29-AS-DPEA-CQDPR6-20230329113210

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802467
Report Date: 02/17/2023
Date Signed: 02/17/2023 03:23:08 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
03/01/2021 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20210301124754

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:	03:30 PM

ALLEGATION(S):

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Staff are not assisting resident with activities of daily living
Staff fail to assist residents timely with care needs
Staff are failing to turn residents as needed
Facility staff are not changing the bedding for residents
Facility staff speaks inappropriately to staff in front of residents in care
Facility staff are not following their menu plan

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 for another complaint investigation (complaint controls # 29-AS-20210226084535 and 29-AS-20200624150217) and also obtained information for this complaint investigation. 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-20210301124754

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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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. The LPA also 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 and with the Culinary Executive Director at 2:32 PM. The LPA also reviewed facility records, including the facility menu and Monthly Consultant Dietician Report.

The allegation of 'Staff are not assisting resident with activities of daily living (ADL)' alleges staff are not assisting residents with hygiene needs. Interviews with residents revealed no issues or concerns regarding staff assistance with ADLs. Staff interviewed also revealed residents are being assisted with hygiene care. Based on the information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of 'Staff are not assisting resident with activities of daily living' is deemed unsubstantiated at this time.

The allegation of 'Staff are failing to turn residents as needed' alleges staff are not repositioning residents as needed. Staff interviewed revealed residents are being repositioned at least every two hours when in bed or as often as needed to prevent redness or sores. Resident interviewed had no complaints regarding assistance with ADLs. Based on the information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation is deemed unsubstantiated at this time.

The allegation of 'Staff fail to assist residents timely with care needs' alleges staff have walked past residents when they are sliding out of their chairs and call for another staff to assist. Interviews with residents from revealed no issues or concerns regarding the timely assistance they receive from staff. Interviews. Based on the information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of 'Staff fail to assist residents timely with care needs' is deemed unsubstantiated at this time.

Report continued on LIC 9099-C.

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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Control Number 29-AS-20210301124754

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 allegation of 'Facility staff are not changing the bedding for residents' alleges staff are not changing resident's soiled bedding. During the 03/05/2021 inspection and 03/18/2022 inspection, the LPA observed a random selection of resident rooms and did not observe soiled bedding. Interviews with residents revealed bedding is washed once a week or as needed. Interviews with staff revealed soiled bedding is washed by the caregivers as needed or weekly by housekeeping. Based on the information obtained there is insufficient evidence to support the allegation occurred. Therefore, the allegation of 'Facility staff are not changing the bedding for residents' is deemed unsubstantiated at this time.

The allegation of 'Facility staff speaks inappropriately to staff in front of residents in care' alleged Staff #1 (S1) yells at staff in front of residents often. Staff interviewed revealed no concerns regarding staff yelling at them. Residents interviewed had not observed any staff yelling at anyone. Based on the information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of 'Facility staff speaks inappropriately to staff in front of residents in care' is deemed unsubstantiated at this time.

The allegation of 'Facility staff are not following their menu plan' alleges the facility is not following the menu. Interview with Michael Callahan, Culinary Executive Director revealed there are times the menu is not followed occasionally due to supply issues. He stated this has happened during COVID but stated the protein always stayed the same and the change may have been an item like the vegetable. Callahan was not aware of any resident complaints regarding this issue. Interviews with residents revealed no major issues or concerns with the food or menu being served. Based on the information obtained, there is sufficient evidence to support the allegation occurred. Therefore, the allegation of 'Facility staff are not following their menu plan' is deemed unsubstantiated at this time.

Exit interview conducted and report reviewed. A copy of the report and appeals rights was 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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