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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802472
Report Date: 01/26/2024
Date Signed: 01/26/2024 05:36:33 PM


Document Has Been Signed on 01/26/2024 05:36 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 N.ASC, 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: 37DATE:
01/26/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Jennifer Diaz/Hazel AspillagaTIME COMPLETED:
05:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Esther Cortez conducted a case management - deficiencies visit inspection due to a deficiency observed during the investigation of complaint control #29-AS-20230818091916.

The LPA met with MedTech (MT) Jennifer Diaz and explained the reason for report. Administrator Sean Beharry could not be present during the visit today and authorized MT Hazel Aspillaga to review and sign the report.

During the complaint investigation, the following deficiencies were observed:

During today's visit, LPA interviewed Staff #1 (S1). During the interview S1 admitted to forcing Resident #1 (R1) and other residents to shower after their refusal. In addition S1 stated that other staff force residents to shower as well after refusal. S1 revealed, that there's is residents who always refuse to shower and that is the only way to get them to shower, however they do not document any shower refusal.

The LPA did not observed a complete and current documentation of shower refusals for Resident #1.

Administrator was available over the phone to review report.

Citations Issued. See LIC 809-D.  Appeal Rights discussed and copy of report issued.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2024
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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Document Has Been Signed on 01/26/2024 05:36 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364


FACILITY NAME: VENTURA GRAND CHATEAU
FACILITY NUMBER: 565802472

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2024
Section Cited
CCR
87468.1(a)(16)

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87468.1(a)(16) Residents in all residential care facilities for the elderly shall have all of the following personal rights: To receive or reject medical care or other services. This requirement is not met as evidenced by:
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Administrator agrees to conduct personal rights trainning with all staff and submit proof to LPA no later than POC due date of 2/09/24.
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Based on interviews, the licensee did not allow R1 the personal right to reject the service of showers, as R1 and other residents are being forced to shower which posed a potential person right risk to residents in care.
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Type B
02/09/2024
Section Cited
CCR87506(a)

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87506(a) Resident Records. A separate, complete, and current record shall be maintained for each resident in the facility, readily available to facility staff and to licensing agency staff and shall contained specified information.
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Administrator will review Title 22, Section 87506-Resident Records and ensure that all the required documents are in the resident files. Licensee will submit a signed written statement that Section 87506(a) was read and understood by 2/09/24
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Based on record review, the licensee did not have a complete and current record of shower refusals for R1 which poses a potential person right 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: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2024
LIC809 (FAS) - (06/04)
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