565802472-12-29-2022-29-AS-KBUY-CMLRB7-20221230115215

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802472
Report Date: 12/29/2022
Date Signed: 12/29/2022 02:49:48 PM

Substantiated

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
03/30/2022 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20220330145608

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:	02:50 PM

ALLEGATION(S):

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Staff hit residents in care
Staff speaks inappropriately to residents in care

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 and obtained pertinent documents and interviewed staff. LPA Olson reviewed records and interviewed staff on 12/21/22, 12/22/22, and 12/23/22. LPA Olson interviewed residents on 12/29/2022. During today’s visit, LPA Olson met with Sean Beharry, Backup Administratorand explained the reason for the visit.

On the allegation: Staff hit residents in care and Staff speaks inappropriately to residents in care. It was alleged Staff 1 (S1) hit Resident 1 (R1) and “several staff witnessed it”. It was also alleged that S1 hit another unknown male resident on 2/25/22 and it was caught on camera. Both incidents were allegedly reported to the (former) Administrator Mark Peralta (A1) yet nothing was done. Reporting Party also alleged S1 speaks rudely to residents and yells at them.
Continued on 9099-C

Substantiated

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 3

Control Number 29-AS-20220330145608

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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LPA Olson interviewed 7 Staff and 2 backup Administrators on 12/21/22 and 12/22/22 regarding the allegations. One Administrator (A2) stated they knew nothing about it and A1 was very strict with the employees and would have told management and taken action against S1 if they witnessed it on camera. The other Administrator (A3) stated they heard about the first incident but didn’t see it. A3 stated that S1 is just “misunderstood” but would never do anything to hurt residents. 5 out of 7 staff interviewed said S1 would never physically harm the resident, and talks loud and may often get frustrated when talking to residents and other staff due to S1 not being fluent in English, and are just misunderstood. 5 out of 7 staff stated S1 is rude and have witnessed S1 saying rude things to residents, talking back to them, not giving them coffee or letting them walk far from their room and say things like, “be quiet”, “don’t hit me, I’ll hit you back”, “move over”, “You’re stubborn”. Staff 2 stated that they witnessed S1 grab residents by their wrist and take them to or from the dining area. S2 stated they witnessed R1 sitting on the bench near the bathrooms when S1 stepped on R1’s foot and pull R1’s hair. LPA asked if they saw why S1 did this and S3 stated when R1 was new to the facility they were very aggressive and may have tried to hit or kick S1, that was very common when R1 first arrived. S2 stated they informed the Administrator (A1) that day in the hallway and after S2 told A1 they didn’t say anything and kept walking. S2 stated they were working on 2/25/22 in the other room when Staff 3 (S3) told them S1 had just hit Resident (R2). Staff 2 stated, I think it was R2 and S3 told me they saw S1 hit R2 and told A1 who had saw it on video. LPA was unable to view the video at the facility. LPA interviewed Staff 3 who stated they witnessed S1 shove spoons in residents mouth when they have their mouth closed. S3 stated they witnessed S1 shove a spoon into R1’s mouth and heard a crunch. The next day R1 was missing a tooth. S3 also stated they witnessed S1 hit R2 on the head and said “shut up”. S3 stated they filled out paperwork for the incident and insisted Administrator 1 review the security footage. S3 stated that A1 and S3 reviewed the footage showing the incident and A1 assured S3 it would be handled. A1 is no longer at the facility and could not be interviewed. One resident interviewed stated S1 had yelled at them before. 2 resident interviewed stated they had witnessed S1 hit their roommate and a third resident stated S1 closed their hand in a door. LPA Olson interviewed S1 who states they have never hit a resident. S1 stated they are hit and hurt by residents but they never hit back. S1 demonstrated on LPA how they help residents up, escort them around, and feed them. S1 stated A1 has talked to them about the correct way to talk to residents and properly lift them but never talked to S1 about a staff or resident claiming they S1 hit someone. Based on interviews the allegations staff hit residents in care and Staff speaks inappropriately to residents in care are Substantiated.

Exit interview conducted, a copy of the report and appeal rights were emailed.

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 3

Control Number 29-AS-20220330145608

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/29/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/30/2022 Section Cited CCR 87468.1(a)(3)	1 2 3 4 5 6 7	87468.1(a)(3) Personal Rights. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature…This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to Issue a counseling memo to S1. Administrator also agreed to train all staff on personal rights and submit training records to CCL by 12/30/22
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply with the above cited section when S1 hit and inappropriately handled residents, which posed an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
Type A 12/30/2022 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	87468.1(a)(1) Personal Rights. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons.…This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to train all staff on personal rights and submit training records to CCL by 12/30/22
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply with the above cited section when S1 verbally abused residents, which posed an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

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 appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

LIC9099 (FAS) - (06/04)

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