565802472-7-11-2024-29-AS-KHEN-D7NQJ2-20240730121200

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802472
Report Date: 07/11/2024
Date Signed: 07/11/2024 04:51:01 PM

Substantiated

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
07/09/2024 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20240709103040

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:	07/11/2024
		UNANNOUNCED	TIME BEGAN:	09:32 AM
MET WITH:	Sean Beharry		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff does not treat resident with respect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted an initial complaint investigation visit. LPA met with administrator Sean Beharry and explained the reason for the visit.

During the investigation, LPA conducted interviews with the administrator starting at 11:52 a.m., Resident 1 (R1) at 11:34 a.m., and multiple staff starting at 11:57 a.m. LPA also reviewed and obtained pertinent records at 12:03 p.m.

The interviews conducted with R1 and staff, other than Staff 1 (S1) confirmed that S1 forcefully grabs the television remote from R1 while R1 is listening to music in the activity room and changes the channel to movies. None of the other residents complain about the music and nobody asks to watch the movies S1 turns on.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

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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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
07/09/2024 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20240709103040

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:	07/11/2024
		UNANNOUNCED	TIME BEGAN:	09:32 AM
MET WITH:	Sean Beharry		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff financially abused resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted an initial complaint investigation visit. LPA met with administrator Sean Beharry and explained the reason for the visit.

During the investigation, LPA conducted interviews with the administrator starting at 11:52 a.m., Resident 1 (R1) at 11:34 a.m., and multiple staff starting at 11:57 a.m. LPA also reviewed and obtained pertinent records at 12:03 p.m.

R1 stated Staff 1 (S1) grabbed their purse and went through their purse without permission. R1 stated there was cash in their purse, however there was no cash missing from their purse.

Based on the interview with R1, the allegation "Staff financially abused resident in care" is deemed Unsubstantiated at this time. Exit interview conducted and report issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

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-20240709103040

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: 07/11/2024

NARRATIVE

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(continued from LIC9099)

In addition, R1 stated they enjoy playing bingo and during bingo S1 goes to get them and take them to the bathroom even though R1 does not need to go to the bathroom. R1 feels this is done by S1 out of spite.
Other staff also stated it seemed to them S1's conduct toward R1 was forceful and seemingly spiteful.

S1 was interviewed and denied the allegations. However, based on statements from witnesses, the allegation "Staff does not treat resident with respect" is deemed Substantiated at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D).

Exit Interview conducted. A copy of the report and appeal rights were issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20240709103040

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/11/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/19/2024 Section Cited CCR 87468.1	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents... This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee will conduct training and counseling with S1 regarding residents' rights and S1's conduct with residents. Evidence of this will be provided to CCL on or before 7/19/2024.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply with the section cited above as, witnesses stated R1 was treated poorly by S1, which posed a potential health and safety risk to resident in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

LIC9099 (FAS) - (06/04)

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