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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802472
Report Date: 02/22/2024
Date Signed: 02/22/2024 03:31:44 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
06/08/2023 and conducted by Evaluator Martha Arroyo
COMPLAINT CONTROL NUMBER: 29-AS-20230608141637
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:
02/22/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Sean Beharry TIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff did not seek timely medical attention for a resident.
Staff did not address a resident’s scabies infection.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs), Martha Arroyo and Valeria Conway conducted a subsequent visit to the facility to issue findings for the above allegations. The initial visit was conducted on 06/13/2023 by LPA M. Arroyo. During today's visit, LPA met with the Administrator, Sean Beharry and the reason for the visit was explained. Entrance interview.

During the initial visit on 06/13/2023, at 10:52 a.m., the LPA conducted a tour of the facility to ensure there are no health and safety concerns, conducted interviews with two Administrators, two staff, and four residents between 11:04 a.m. and 12: 40 p.m., conducted a file review at 11:35 a.m., and obtained copies of pertinent documents relevant to the investigation. Hospice records were requested and reviewed.

Continued on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
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 7
Control Number 29-AS-20230608141637
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: 02/22/2024
NARRATIVE
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Continued from LIC 9099...

It was alleged that staff did not seek timely medical attention for a resident. It was reported that in October 2022, Resident #1 (R1) was observed on several occasions to have dry palms with skin peeling off, but even after applying ointment, on December 2022, R1 had developed open cracks diagnosed as cellulitis. It was also reported that in February 2023, R1 had fungus on their fingernail which resulted in R1 having their fingernail removed; however, the fungus was still there. Records review of Re-Cert Assessment dated 11/15/2022, noted R1 with atopic dermatitis on bilateral hands with skin treatments in place; and on the Re-Cert Assessment dated 01/12/2022, it stated that R1’s chronic bilateral palm dermatitis was not responding to topical treatments on 12/02/2022, which caused it to worsen into cellulitis of skin and the doctor ordered oral antibiotics Keflex 500mg x7 days started on 12/09/2022. Additionally, review of communication log dated 02/11/2023, noted R1 with left middle finger fungal sore. New orders and initial treatment was started same day to treat x 14 days and then to re-evaluate. Treatment was started again on 03/07/2023 for Lamisil 250mg x6 weeks with Fungi-Nail solution topical treatment and consultations with a podiatrist and recommendations were made after. Furthermore, both facility staff and hospice were continuously treating R1’s dermatitis and fingernail fungus. Based on the information obtained during the course of the investigation, the Department does not have sufficient evidence to support the allegation of, “staff did not seek timely medical attention for a resident”. Therefore, this allegations is being deemed Unsubstantiated at this time.

It was also alleged that staff did not address a resident’s scabies infection. It was reported that in April 2023, R1 had bites and a rash on their skin which was reported to being a skin condition and not scabies; however, it was not until June 2023, when R1 was finally diagnosed and treated for scabies. Information obtained during the course of the investigation revealed that R1’s skin rash was being treated by Hospice Care of the Valley and facility staff as both hospice and facility staff were following skin treatment orders to relieve R1’s skin rashes for several weeks. Although R1’s skin rashes seemed to be flaring up even after being treated, hospice continued to prescribe different types of topical skin treatments to try and alleviate R1’s skin rashes.

Continued on LIC 9099C...

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 29-AS-20230608141637
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: 02/22/2024
NARRATIVE
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Continued from LIC 9099C...

Records review revealed that between April 2023 and June 2023, hospice had prescribed different skin treatments such as Elimite, Zeasorb Powder and Triamcinolone cream to continue to find a treatment that would work for R1’s skin rashes. Furthermore, the facility had conducted a skin sweep assessment in April 2022 that had resulted in negative results. This ultimately swayed the facility to hire a dermatology company to come out to the facility and assess the resident at the facility. However, even after all the testing, hospice staff stated R1’s skin rash was never diagnosed. Additionally, hospice added that although they were unable to find a cause, they did alternate between different treatments to try and control the skin rashes as well as give as much comfort to R1. Based on the information obtained during the course of the investigation, the Department does not have sufficient evidence to support the allegation of “staff did not address a resident’s scabies infection”. Therefore, this allegation, is deemed Unsubstantiated at this time.

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

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
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
06/08/2023 and conducted by Evaluator Martha Arroyo
COMPLAINT CONTROL NUMBER: 29-AS-20230608141637

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:
02/22/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Sean Beharry TIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff did not provide adequate supervision, resulting in a resident falling and sustaining injuries.
Staff did not ensure a resident’s medical equipment was maintained.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs), Martha Arroyo and Valeria Conway conducted a subsequent visit to the facility to issue findings for the above allegations. The initial visit was conducted on 06/13/2023 by LPA M. Arroyo. During today's visit, LPA met with the Administrators, Sean Beharry and Michael Dimaguila, and at this time the reason for the visit was explained. Entrance interview.

During the initial visit on 06/13/2023, at 10:52 a.m., the LPA conducted a tour of the facility to ensure there are no health and safety concerns, conducted interviews with two Administrators, two staff, and four residents between 11:04 a.m. and 12: 40 p.m., conducted a file review at 11:35 a.m., and obtained copies of pertinent documents relevant to the investigation. Hospice records were requested and reviewed.

Continued on LIC 9099C...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 29-AS-20230608141637
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: 02/22/2024
NARRATIVE
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Continued from LIC 9099...

It was alleged that staff did not provide adequate supervision, resulting in a resident falling and sustaining injuries. It was reported that Resident #1 (R1) is wheelchair dependent, and on 09/04/2022, R1 was injured after falling out of the wheelchair. It was also reported that after the fall, R1 had a large welt on their forehead with some skin scraped off, and bruises were observed on R1’s arms and knees. Information obtained during the course of the investigation revealed that R1 was admitted to Hospice Care of the Valley on 01/20/2022; and Comprehensive Nursing Assessment dated, 01/20/2022 stated R1 was bed and chair bound as well as required total assistance with activities of daily living (ADL). Additionally, the LPA reviewed hospice nursing notes that included the communication log between facility staff and hospice staff regarding R1 dated 01/24/2022 – 06/13/2023. Communication log from 09/04/2022 stated that facility staff informed hospice that R1 had an unwitnessed fall in the dining room. R1 was found next to their wheelchair with a large bump ecchymosis (bruise) on their left forehead and a bruise with swelling on R1’s right knee lower shin area. Thereafter, hospice nurse instructed facility staff to place R1 on bed rest and ice both sites three times a day. Additionally, hospice staff educated facility staff on fall safety precautions to which facility staff expressed understanding. Furthermore, R1 required assistance with all ADL’s as well as staff supervision at all times. For this reason, because R1 was left unattended, R1 suffered a fall from their wheelchair resulting in R1 sustaining injuries while in the dining room. Therefore, based on the information obtained and reviewed, the allegation of, “staff did not provide adequate supervision, resulting in a resident falling and sustaining injuries” is being deemed Substantiated at this time.

It was further alleged that staff did not ensure a resident’s medical equipment was maintained. It was reported that R1 suffered a fall on 09/04/2022 and it was determined that the wheelchair brakes were not working. Records reviewed that included the communication log between facility staff and hospice staff dated 09/05/2022, revealed that hospice spoke with the facility administrator and staff to inquire about R1’s unwitnessed fall from 09/04/2022 in the dining room which left R1 with forehead laceration and right knee swelling.

Continued from LIC 9099...

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 29-AS-20230608141637
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: 02/22/2024
NARRATIVE
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Continued from LIC 9099C...

During this conversation, facility staff stated that incident occurred after lunchtime when R1 was wheeled to the dining table, but wheels unlocked and must have backed away from table causing R1 to slide down to the floor. However, R1’s wheelchair was not reported faulty to hospice until after the fall incident from 09/04/2022 when hospice called the facility to obtain more information on the incident the following day. Additionally, interviews conducted with staff revealed that hospice is usually good about replacing medical equipment and added that facility staff typically observes if equipment is malfunctioning as they are the ones assisting the residents on a daily basis. Furthermore, hospice ordered a new reclining wheelchair for R1 the following day to prevent another accident. Based on the information obtained and reviewed, the allegations of, “staff did not ensure a resident’s medical equipment was maintained” is being deemed Substantiated at this time.

The following deficiencies were observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties.



Exit interview conducted. A copy of the report and appeal rights were provided.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 29-AS-20230608141637
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: 02/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/22/2024
Section Cited
CCR
87464(f)(1)
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(f)Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).

This requirement is not met as evidenced by:
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Licensee will submit a plan on how the facility will ensure residents will be supervised based on their individual needs. Submit to CCL by 02/29/2024.
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Based on the information obtained and reviewed, the Licensee did not comply with the section cited above as, R1 was left unsupervised resulting in R1 falling off their wheelchair and sustaining injuries, which posed an immediate health and safety risk to resident in care.
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Type B
02/22/2024
Section Cited
CCR
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(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

This requirement is not met as evidenced by:
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Licensee will submit a plan on how the facility will ensure all medical equipment is maintained and report any faulty equipment to the proper agencies. Submit to CCL by 02/29/2024.
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Based on the information obtained and reviewed, the Licensee did not comply with the section cited above as, staff failed to report faulty wheelchair brakes to hospice causing R1 to have an unwitnessed fall in the dining room, which posed a potential health and safety risk to resident 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: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7