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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802472
Report Date: 08/23/2023
Date Signed: 08/23/2023 06:19:30 PM


Document Has Been Signed on 08/23/2023 06:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:VENTURA GRAND CHATEAUFACILITY NUMBER:
565802472
ADMINISTRATOR:MICHAEL DIMAGUILAFACILITY TYPE:
740
ADDRESS:5430 TELEGRAPH ROADTELEPHONE:
(805) 642-2567
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:49CENSUS: 38DATE:
08/23/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Sean Beharry TIME COMPLETED:
06:30 PM
NARRATIVE
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Licensing Program Analysts (LPA) Esther Cortez conducted an unannounced Case Management -Deficiencies visit in conjunction with a complaint visit (Complaint Control #29-AS-20230818091916). The purpose of the visit is to issue citations for deficiency observed during the complaint investigation which is not related to the complaint. The LPA met with Administrator Sean Beharry and the reason for the visit was explained.

On today’s visit, the LPA was denied access to two staff rooms located in the basement. Administrator informed the LPA that the rooms were locked by staff who were not present at the facility. The Administrator did not have a copy of the key to staff rooms and the LPA was not able to inspect both rooms.

During the facility tour the Administrator stated that the second floor was only for staff. Both entry stairwells to the upstairs area are locked with key from the inside and outside, inhibiting residents from going upstairs or back to the first floor. At approximately 10:00 a.m. the LPA observed resident #1 (R1) in the living room area on the second floor. Upon observation, the administrator stated that R1 lives in one of the upstairs bedrooms with staff (S1) who is also their family member. The LPA also observed the following items on the second floor unlocked and accessible to R1: Acetaminophen pain reliever pills, prescribed medications, and over the counter Vitamin D on a shelf in the upstairs living area. An unlocked drawer with knives in the kitchen. One unlocked cabinet with Raid, Disinfectant Spray, Mr. Clean Antibacterial cleaning solution, and Mop&Glo 3-in-1 cleaning solution in the kitchen. An unlocked office with scissors. One unlocked cabinet with a bottle of bleach, arm & harmer laundry detergent, and Lysol Spray in the unlocked staff bathroom. One unlocked glass cabinet with Raid, paint gloss, and a large knife.

Report will continue on LIC809-C
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: VENTURA GRAND CHATEAU
FACILITY NUMBER: 565802472
VISIT DATE: 08/23/2023
NARRATIVE
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During file review, the LPA identified that Resident #2 (R2) requires an updated physician’s report (LIC602), and appraisal/needs and services plan (LIC625) due to the diagnosis of dementia. The LPA observed R2’s LIC602 dated 9/20/20 and LIC625 dated 9/24/2020 and not filled out.

Pursuant to Title 22 of the California Code of Regulations Division 6, the following deficiencies were cited (refer to LIC 809-D).

Exit interview conducted. A copy of the report and appeal rights provided to Administrator Sean Beharry

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 08/23/2023 06:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364


FACILITY NAME: VENTURA GRAND CHATEAU
FACILITY NUMBER: 565802472

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/24/2023
Section Cited
CCR
87468.1(a)(6)

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87468.1(a)(6) Personal Rights of Residents in All Facilities (a) Residents ... shall have all of the followin....:(6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This requirement is not met as evidenced by:
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The administrator agreed to do the following:
1. Address this with the board of directors in an all-staff meeting, and discuss how the community will regain compliance with Regulation 87468.1(a)(6). Inform CCL when this has ttaken place, no later than 8/24/2023, end of day.
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Based on observation and interview, the licensee did not comply with the section cited above, as both stairwells doors to the 2nd floor are locked from the inside & outside, inhibiting R1 from going back to the 1st floor and exiting which poses an immediate personal rights risk to residents in care.
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Type A
08/24/2023
Section Cited
CCR87309(a)

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87309(a)Disinfectants, cleaning solutions, knives, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
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Upon observation the Administrator designated staff to start locking all cabinets and drawers with hazardous items and keep them locked and inacceible to residents in care.
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Based on observation, the licensee did not comply with the section cited above as disinfectants, cleaning solutions, knives, medications were accessible to R1 in unlocked cabinets, drawers and shelfs on the 2nd floor which poses an immediate health and safety risk to residents in care.
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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: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4


Document Has Been Signed on 08/23/2023 06:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364


FACILITY NAME: VENTURA GRAND CHATEAU
FACILITY NUMBER: 565802472

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/24/2023
Section Cited
CCR
87755(a)

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87755 Inspection Authority of the Licensing Agency (a) Any duly authorized officer, employee or agent of the licensing agency may...inspect the entire premise of any place providing services at any time, with or without advance notice. This requierment was not met by:
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The administrator agrees to make copies of staff room keys by 8/24/23.
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Based on observation, the licensee did not comply with the section cited above, as the LPA was not granted access to two staff rooms due to staff not being present. Administrator did not have a copy of the keys which poses an immediate health and safety risk to residents in care.
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Type B
09/06/2023
Section Cited
CCR87705(c)(5)

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87705(c)(5) Care of Persons with Dementia (c) Licensees who accept... residents with dementia shall.... ensuring the following: (5)Each resident with dementia shall have medical assessment and reappraisal,.. at least annually…This requirement is not met as evidenced by:
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Administrator agrees to have R2's physicians report and appraisal needs and services updated. The administrator agrees to submit proof to CCL BY 9/6/23

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Based on record review, the licensee did not comply with the section cited above as
The licensee failed to develop a care plan to meet R1’s needs and update the physicians report annually due to their diagnosis of dementia which posed a potential health and safety risk to residents in care.
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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: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4