565802472-1-26-2024-29-AS-KLOZ-CZZU2E-20240131141148

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802472
Report Date: 01/26/2024
Date Signed: 01/26/2024 05:26:43 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
08/18/2023 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20230818091916

FACILITY NAME:	VENTURA GRAND CHATEAU		FACILITY NUMBER:	565802472
ADMINISTRATOR:	MICHAEL DIMAGUILA		FACILITY TYPE:	740
ADDRESS:	5430 TELEGRAPH ROAD		TELEPHONE:	(805) 642-2567
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	49	CENSUS: 37	DATE:	01/26/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Jennifer Diaz/Hazel Esaspillaga-MT		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff do not ensure resident's personal hygiene needs are met

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Esther Cortez arrived unannounced at 9:45 a.m. to conduct a subsequent compliant visit. The LPA met with MedTech (MT) Jennifer Diaz and explained the reason for the visit. Administrator Sean Beharry could not be at the facility during today's visit and authorized MT Hazel Esaspillaga to sign and receive the report.

On 08/23/23, the LPA toured the facility, obtained documents, and conducted staff and resident interviews from 8:50 a.m. - 6:00 p.m. During today's visit, the LPA conducted a file review, obtained documents, and interviewed staff and Individual #1 (I1) who cared for R1 in 2023 from 9:45 a.m. to 1:00 p.m.

Report will continue on LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (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.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230818091916

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
	VISIT DATE: 01/26/2024

NARRATIVE

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This report was amended for privacy reasons.

It is alleged that ‘Staff do not ensure resident's personal hygiene needs are met.’ The concern of the RP is that resident #1 (R1) smelled of feces, had feces on their clothes and was not wearing any underwear. It was further reported that R1 was disheveled and unkempt. During this investigation LPA Cortez conducted interviews with facility staff, R1, Individual #1 (I1) who cared for R1 in 2023, and a family member of the resident. In addition, R1’s records were reviewed. Staff Interviews revealed that R1 refuses to shower or change and gets aggressive with the staff when they attempt to assist. Staff also indicated that when residents are observed with soiled clothing they are changed. During LPA's interview with R1, it was learned that R1 does not like anyone in their room and states that they are independent and do not want any help. Interview with I1, revealed that they have attempted to assist with showering R1, however R1 refused, was abusive, resistant, and had a tendency to hit. Interview with R1's family revealed that they have no concerns with the care the facility is providing at this time, based on R1’s behavior. R1’s family member acknowledges R1 can be aggressive and in addition tends to pack away or lose their clothes. R1’s family member also revealed they visit R1 once or twice a week, and even though they have observed stains on R1’s clothing they have been old stains and have never seen R1 with feces or fresh stains. The LPA observed documentation of R1’s shower refusals while they were receiving Hospice care in previous years. During today’s visit, at 10:50 a.m. the LPA observed a MedTech attempt to assist R1 with changing, however R1 threw the clothes and started to yell and yelled at the MT to get out of their room. Based on the information gathered through the interviews, and observation there is insufficient evidence to support the above allegation. Therefore, although the allegation may have happened, or may be valid, this allegation is deemed Unsubstantiated at this time.

Administrator was available over the phone to review report.

Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (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

LIC9099 (FAS) - (06/04)

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