565802472-6-16-2020-31-AS-MSCR-BQN42V-20200616184346

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802472
Report Date: 05/27/2020
Date Signed: 06/16/2020 04:36:22 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE. SUITE 200
GOLETA, CA 93117

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/28/2020 and conducted by Evaluator Joann Rosales

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20200128144853

FACILITY NAME:	VENTURA GRAND CHATEAU		FACILITY NUMBER:	565802472
ADMINISTRATOR:	MARK DEN PERALTA		FACILITY TYPE:	740
ADDRESS:	5430 TELEGRAPH ROAD		TELEPHONE:	(805) 642-2567
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	49	CENSUS: 35	DATE:	05/27/2020
		UNANNOUNCED	TIME BEGAN:	01:52 PM
MET WITH:	Mark Peralta		TIME COMPLETED:	01:58 PM

ALLEGATION(S):

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Staff allow resident #2 (R2) to lie down on resident # 1 (R1) bed leaving feces on the bed
Staff left resident #1 (R1) in soiled clothing for extended amount of time
Facility is not adequately staffed to meet residents needs

INVESTIGATION FINDINGS:

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*LPA amended 5/27/2020 report to include additional information on the complaint investigation report.* Licensing Program Analyst (LPA) JoAnn Rosales conducted a subsequent complaint investigation to deliver final investigation findings telephonically with Administrator Mark Peralta due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures.

Concern was that staff allow resident #2 (R2) to lie down on R1’s bed leaving feces on the bed. Interview with R1’s family member on 2/5/2020 at 1:34 pm revealed and observed that R2 would lie down on R1’s bed but have not observed feces left on R1’s bed. Facility residents were interviewed, however, due to R1 and R2’s cognitive impairment, LPA was unable to interview these residents. Interview with R3 on 2/5/2020 at 9:52 am revealed that R2 would go into R3’s room and would lie down on R3’s bed but not observed feces left on R3’s bed. R3 would call staff to remove R2 out of the room. Interview with R4 and R5 on 2/5/2020 starting at 9:58 am revealed that R2 was observed lying down on their roommates’ beds but have not observed feces left their beds. Both stated would call staff to remove R2 out of their rooms. Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maryjo Schnitzer	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Joann Rosales	TELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2020

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 31-AS-20200128144853

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE. SUITE 200
GOLETA, CA 93117

FACILITY NAME: VENTURA GRAND CHATEAU	FACILITY NUMBER: 565802472
	VISIT DATE: 05/27/2020

NARRATIVE

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Interview with Administrator on 2/5/2020 at 1:52 pm denied the allegation. Interview with S1 on 2/5/2020 at 10:17 am revealed being aware of R2 laying on other residents' beds, however, stated able to redirect R2 to leave the residents’ rooms. S1 also stated not being aware of R2 leaving feces on R1’s bed. Interviews with S2, S3, S4 and S5 on 2/5/2020 starting at 10:36 am. All denied the allegation. S6 was interviewed on 4/30/2020 at 3:42 pm, also unaware of the allegation. On 2/5/2020, LPA reviewed R2’s facility records and verified that R2 did not require one-on-one staff supervision and able to follow re-direction by staff in the event R2 mistakenly would visit another residents’ rooms and lie on their beds. Based on information obtained, staff quickly responded and re-directed R2 out of the other residents’ rooms. Allegation is Unsubstantiated at this time.

Concern was that staff left resident #1 (R1) in soiled clothing for extended amount of time. Interview with Administrator, S1, S3, S4 and S5 on 2/5/2020 starting at 10:17 am and S6 on 4/30/2020 at 3:42 pm. All denied the allegation. Interview with R1’s family member on 2/5/2020 at approximately 1:34 pm, revealed that this family member visited R1 daily, after lunch and did not observe R1 in soiled clothing. Based on information obtained, allegation is Unsubstantiated at this time.

Concern was that the facility is not adequately staffed to meet residents needs when staff #5 (S5) asked R1’s family member to care for R1 so that facility staff “can care for other residents.” LPA unable to interview R1 and R2 due to cognitive impairment. Interview with R3, R4, R5, R6, Administrator, S1, S3, S4, S5 on 2/5/2020 starting at 9:58 am and S6 on 4/30/2020 at 3:42 pm revealed that the facility has sufficient staffing to meet resident’s needs. On 2/5/2020, LPA reviewed staff shift schedule for the period 1/28/2020 – 2/7/2020. For shifts: 6:30a to 2:30 pm and 2:30pm- 10:30pm, 2 caregivers, care giver supervisor, and a med tech are on shift. For NOC shift-10:30pm – 6:30am, 2 caregivers, one manager on call. S5 when interviewed on 2/5/2020 at 1:18 pm denied the allegation.

Based on the information obtained, allegation is Unsubstantiated at this time. A telephonic exit interview was conducted with the Administrator, and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Maryjo Schnitzer	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Joann Rosales	TELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2020

LIC9099 (FAS) - (06/04)

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