565802472-12-29-2022-29-AS-KBUY-CMLRDH-20221230115557

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802472
Report Date: 12/29/2022
Date Signed: 12/29/2022 02:40:47 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
04/06/2022 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20220406074104

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:	12/29/2022
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Sean Beharry, Backup Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff sexually abused resident
Staff violated residents personal rights
Staff are not assisting resident with activities of daily living

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted an unannounced complaint visit to issue final findings. LPA Dulek conducted the initial investigation 04/06/22 between 9:25am and 12:45pm, and obtained pertinent documents. On 04/06/2022, the Department received a complaint regarding allegations of abuse and neglect. The complaint was referred to Community Care Licensing Investigations Branch (IB) and assigned to Investigator Robert Kujawa. LPA Olson reviewed records and interviewed staff on 12/21/22, 12/22/22, and 12/23/22. LPA Olson interviewed residents on 12/29/22. During today’s visit, LPA Olson met with Sean Beharry, Backup Administrator and explained the reason for the visit.

Investigator Kujawa conducted interviews with R1 on 06/21/2022, at approximately 8:52am; with the Staff on 06/14/2022, at approximately 1:48pm; with Administrator Michael Dimagulia on 6/14/2022, at approximately 2:04pm; and attempted to contact Reporting Party multiple times, including postmarked mail on 06/15/2022 yet received no response. Additionally, Investigator Kujawa obtained and reviewed copies of facility records.
Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

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 5

Control Number 29-AS-20220406074104

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: VENTURA GRAND CHATEAU	FACILITY NUMBER: 565802472
	VISIT DATE: 12/29/2022

NARRATIVE

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Information gathered reflected R1 was admitted to the facility on 02/18/2022 and moved out on 04/05/2022.

On the allegation: Staff sexually abused resident and Staff violated residents personal rights; It was alleged that during the week of 3/27/22, S1 stuck their finger up R1’s rectum and left it there for an extended period of time. It was alleged that it happed two more times in early April. It was also alleged that S1 stole R1’s phone and showed the pictures of R1’s spouse to other staff and called R1 and their spouse “disgusting”.

Investigator Kujawa interviewed R1 on 6/21/22 who stated S1 touched them inappropriately. R1 stated they had diarrhea and S1 showered them to clean them off. According to R1, when S1 was showering R1, S1 put their finger up R1’s butt one time “very quickly”. When asked if R1 had a good relationship with S1, R1 stated S1 was an excellent caregiver; S1 was always very nice and give them ice cream whenever they wanted. However, R1 did not like the “nice treatment” they received because R1 stated it made them uncomfortable because they believed S1 was a “homosexual”. Investigator asked if S1 ever did or said anything else inappropriate and R1 said “no” and they did not talk to S1 after the incident much. R1 also stated they reported the incident the “same day” to facility staff.

Investigator Kujawa interviewed Administrator on 6/16/22 around 2:04 PM. Administrator stated R1 has made multiple complaints about 4 separate staff: a staff doing laundry, R1 complained about a staff who tried to help charge R1’s phone, a Medtech went into R1’s room and didn’t address R1 a certain way, and these allegations against S1. Investigator reviewed documentation that confirmed R1 got frustrated at facility staff for various reasons. Administrator stated S1 gave R1 a shower on 3/16/22 and R1 reported the allegations on 03/25/22. Administrator stated they contacted R1’s Family Member (FM1) after learning of the allegations and they understood how R1 maybe upset about S1 cleaning their private area. Administrator stated they talked to multiple staff and found no evidence of anything inappropriate and no other resident has ever had any prior complaints or allegations against S1 regarding inappropriate touching. Investigator Kujawa asked why there was approximately a nine-day gap between the shower and report. Administrator stated R1 has a diagnosis of dementia and would be confused and forgetful at times.

Investigator Kujawa interviewed Staff 1 (S1) on 6/14/22 around 1:48 PM. S1 stated R1 and S1 had a great relationship until R1 got upset out of nowhere and made false allegations against S1. S1 stated R1 has a history of making allegations against facility staff. Continued on 9099-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 29-AS-20220406074104

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: VENTURA GRAND CHATEAU	FACILITY NUMBER: 565802472
	VISIT DATE: 12/29/2022

NARRATIVE

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When asked to describe what happened during the shower, S1 stated they had only showered S1 once, and one week later R1 stated S1 sexually abused R1 and inappropriately touched R1. S1 stated they were very shocked when they learned about the allegation and has “absolutely not” touched R1 inappropriately. S1 stated R1 had some buildup of fecal matter in R1’s buttock area and advised R1 that S1 would have to clean it and R1 stated they understood. S1 then cleaned the area but not in an inappropriate way. S1 was concerned if they didn’t clean R1 well, R1 would complain. When asked why R1 took so long to make the report, S1 stated they didn’t know and they had a good relationship but thinks that R1 got mad at S1 over something and made the complaint. S1 stated R1 often would get mad at staff and make false allegations against them.

LPA Olson reviewed a LIC 624 Unusual Incident/Injury Reports for R1 on 3/27/22 that stated S1 was making R1 a cup of coffee when R1 started accusing S1 of taking their phone and showing a picture of R1’s spouse to other staff and laughing. S1 stated this did not happen, R1 yelled at S1 to get out and S1 immediately left and sent in another staff to finish making the coffee. On 3/11/22 there was another Incident report that stated R1 asked to talk to Staff 2 (S2) saying R1 needed to be changed and the sheets needed to be cleaned because they had an accident. Later that day R1 called to see if the laundry was ready and stated S2 was yelling at R1. Facility charting notes on 3/11/22 stated after S2 went in to help R1, Staff 3 (S3) heard R1 screaming at S2 calling S2 stupid and told them to shut up. When asked what happened S2 stated they had to remove a blanket from R1 and move the table tray to change R1 and R1 started yelling at S2. Later that day S3 asked R1 if S2 was the staff who upset R1 and R1 stated, “oh no that’s not (S2), I would never forget (S2’s) face and voice.”

LPA Olson reviewed a facility note regarding a conference call with R1’s Family Member (FM1) after learning about the allegations brought to Administrator Mark Peralta. “We discussed the incident regarding cleaning (R1) bowel movements in the rectal area due to loose stool around (R1’s) rear/rectal area. We provided information that care provider told (R1) ‘(S1) would need to clean the area thoroughly due to dried bowels around the rectal area’ We also addressed Administrator Peralta sitting with R1 for 3 hours in order to address (R1’s) concerns. We also relayed to (FM1), we provided (R1) several choices of primary care staff in order to ensure (R1’s) comfort and safety."

LPA Olson reviewed facility charting for R1. It stated on 2/19/22 Resident had a shower and shave as requested. Continued on 9099-C (pg4)

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 29-AS-20220406074104

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: VENTURA GRAND CHATEAU	FACILITY NUMBER: 565802472
	VISIT DATE: 12/29/2022

NARRATIVE

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On 3/1/22- Resident has been showing signs of forgetfulness especially when it comes to medicine. All bedtime meds are being given at 8pm. R1 forgets that their meds were already given.

On 3/13/22- Resident said staff slammed R1’s tray down aggressively and said staff was in a bad mood. Staff stated they were not in a bad mood and apologized if they thought that and they wouldn’t treat anyone in that nature. R1 stated no problem and maybe it was a misunderstanding.
On 3/13/22- Resident called for help and complained about staff members being rude to (R1).

On 12/29/2022, LPA interviewed 9 residents, who indicated they were not abused by staff, staff were not inappropriate with them, and their needs were being met. Based on record review and interviews, there is insufficient evidence to prove the allegations staff sexually abused resident and Staff violated residents’ personal rights, and they are deemed Unsubstantiated at this time.

On the allegation: Staff are not assisting resident with activities of daily living. It was alleged that R1 sits in a recliner chair all day in the same diaper, and when R1 asks to be walked to the bathroom, staff tell R1 to go in R1’s diaper. R1 will ask to stand and walk but staff say they don't have time or they can only walk them once a week. It was also alleged that when R1 asks for a shower, they were told they can only get a shower once a week and one time when the shower staff was on vacation, R1 did not get showered for two weeks. Additionally, R1 asks for their food to be cut, or asks to help shave due to arthritis, and staff state they don’t do that. LPA Olson reviewed facility charting for R1. On 2/19/22 it stated: Resident had a shower and shave as requested. Interviews revealed R1 had a shower on 3/16/22. LPA Olson interviewed Administrator and 8 staff who all stated that R1 was very verbal. All 8 staff stated that they showered R1 at least once per week and wiped down R1 daily. Staff stated they consistently changed R1 when asked, R1 was verbal and would call using the pendant when they needed assistance. Staff 4 (S4) stated they checked on R1 every hour and would take them to the bathroom, on walks, and change R1 when asked. R1 asked once for their food to be cut and S4 helped R1. S4 also stated that they shaved R1 twice a week. All staff interviewed stated R1 was difficult and would complain about everything and everyone. Staff all stated they only showered R1 once per week because R1 refused a lot and would make excuses. Resident 1’s shower day was on Mondays and Thursdays. Staff 3 stated that R1 was wiped down and given a sponge bath on off days (Tuesdays, Wednesdays, Fridays and Sundays). S3 stated all residents are clean and get showers more often than not because staff usually wipe down or shower residents after an accident. LPA Olson spoke with Resident 1 (R1) on 12/22/22 about these allegations. Continued on 9099-C (pg 5)

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 29-AS-20220406074104

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: VENTURA GRAND CHATEAU	FACILITY NUMBER: 565802472
	VISIT DATE: 12/29/2022

NARRATIVE

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Resident said they are all true and the staff neglected R1 and never checked or helped with anything. LPA said a staff stated they would check on R1 every hour and R1 said no, S4 was more attentive than the others and R1 was happy when S4 would work. LPA stated that another staff stated they would walk R1 around and encourage them to leave their room. R1 stated that yes, S5 was very nice and would help with the laundry and walk R1 around. R1 stated that staff would wipe R1 with soap and a washcloths or wipes but never showered R1. R1 stated staff would help cut food or shave if they asked for help but thought that they shouldn’t have to ask and staff should just know to do it because R1 suffers from Neuropathy and it’s painful to do things. Based on interviews, the allegation Staff are not assisting resident with activities of daily living is Unsubstantiated at this time.

Exit interview conducted and a copy of this report issued.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

LIC9099 (FAS) - (06/04)

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