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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802472
Report Date: 07/11/2024
Date Signed: 07/11/2024 04:55:39 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
06/13/2023 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20230613124133
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:
07/11/2024
UNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Sean BeharryTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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9
Staff member physically abuses residents in care.
Staff member handles residents in care in a rough manner.
Staff member is not according resident(s) dignity while in care.
Staff member is unable to meet the needs of residents in care due to a language barrier.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent 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. LPA previously interviewed residents on 6/20/2023.

Interviews with residents and staff confirmed that Staff 1 (S1) has been observed handling residents roughly and inappropriately. S1 has been observed including but not limited to twisting resident's wrists while changing/cleaning resident to force resident to comply with prompts, pulling a resident's hair and

(continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 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)
Page: 1 of 6
Control Number 29-AS-20230613124133
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)

stepping on that resident's foot, forcing residents to sit down at a chair and shoving the table so close to them they cannot get up, leaving residents in geri-chairs to restrict their movement, yelling at residents who do not understand S1 due to a language barrier, and changing a resident's briefs while standing in the hallway not affording the resident privacy or dignity.

Based on the observations by those interviewed, the following allegations are deemed Substantiated:
Staff member physically abuses residents in care.
Staff member handles residents in care in a rough manner.
Staff member is not according resident(s) dignity while in care.
Staff member is unable to meet the needs of residents in care due to a language barrier.

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) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 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: 2 of 6
Control Number 29-AS-20230613124133
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 A
07/19/2024
Section Cited
CCR
87468.1(a)(3)
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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: (3)To be free from punishment, humiliation, intimidation, abuse...This requirement is not met as evidenced by:
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Licensee will hire an outside vendor to conduct training with S1 regarding personal rights of clients and submit evidence of this training by 7/19/2024.
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Based on interviews with residents and staff, the Licensee did not comply with the section cited above as, S1 has been observed multiple times mistreating residents, which poses an immediate health and safety risk to resident in care.
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Type A
07/19/2024
Section Cited
CCR
87
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87608 Postural Supports (a) ...Postural supports may be used under the following conditions.(1)Postural supports shall be limited to appliances or device to achieve proper body position... to improve a resident's mobility... rather than restrict movement. This requirement is not met as evidenced by:
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Licensee will conduct training regarding postural supports with all care staff and provide evidence of training to CCL on or before 7/19/2024.
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Based on interviews with residents and staff, the Licensee did not comply with the section cited above as, S1 has been observed multiple times using geri-chairs and tables to restrict residents' movement, which poses an immediate 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) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 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)
Page: 3 of 6
Control Number 29-AS-20230613124133
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
87411(d)(3)
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87411 Personnel Requirements - General (d) All personnel shall be given on the job training...(3) Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement is not met as evidenced by:
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Licensee will counsel S1, provide communication training and provide evidence of training to CCL on or before 7/19/2024.
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Based on interviews with residents and staff, the Licensee did not comply with the section cited above as, S1 has been observed yelling at residents due to a language barrier, which poses 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) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 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)
Page: 4 of 6
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
06/13/2023 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20230613124133

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:
07/11/2024
UNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Sean BeharryTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff member does not follow proper food sanitation practices.
Facility does not have enough staff to meet the needs of residents in care.
Untrained staff member is providing care to residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent 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. LPA previously interviewed residents on 6/20/2023.

LPA reviewed training records for Staff 1 (S1) and appeared to have all required initial and subsequent annual training. Therefore, the allegation "Untrained staff member is providing care to residents" is deemed Unsubstantiated at this time.

(continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 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)
Page: 5 of 6
Control Number 29-AS-20230613124133
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)

LPA interviewed staff and residents regarding S1 handling food. None of those interviewed had ever observed S1 mishandling food or beverages. Therefore, the allegation "Staff member does not follow proper food sanitation practices" is deemed Unsubstantiated at this time.

LPA interviewed staff and residents regarding the facility staffing. Staff indicated the facility is fully staffed and when someone calls out they can find coverage. The residents did not notice any issues with the number of staff at the facility. Therefore, the allegation "Facility does not have enough staff to meet the needs of residents in care" is deemed Unsubstantiated at this time.

Exit interview conducted. Copy of report issued.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 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: 6 of 6