565802472-5-2-2025-29-AS-KBUY-DH4THS-20250528144512

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802472
Report Date: 05/02/2025
Date Signed: 05/02/2025 04:14:07 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
04/25/2025 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20250425111303

FACILITY NAME:	VENTURA GRAND CHATEAU		FACILITY NUMBER:	565802472
ADMINISTRATOR:	SEAN BEHARRY		FACILITY TYPE:	740
ADDRESS:	5430 TELEGRAPH ROAD		TELEPHONE:	(805) 642-2567
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	49	CENSUS: 31	DATE:	05/02/2025
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Sean Beharry		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff restrains resident by securing resident's shoe laces to the wheelchair foot rest.
Resident enters another resident's room and goes through resident's personal items.
Staff use furniture to block entrance to resident's room to prevent another resident from entering but it also blocks the resident and visitors from entering their room.

INVESTIGATION FINDINGS:

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

LPA spoke with administrator regarding this complaint starting at 10:30 a.m. LPA conducted interviews with five staff starting at 10:41 a.m. At noon LPA conducted a brief facility tour. LPA observed Resident 1 (R1) and Resident 2 (R2) eating lunch. LPA attempted to speak with R1 but they were not responsive to questions. R2 nodded and said "hi" but otherwise did not respond to questions.

Based on interviews with the administrator and staff, R2 has a tendancy to enter R1's room, as well as other residents' rooms, takes out all of their personal items and places them on the bed to be packed up. R2 tends

(continued on LIC9099-C)

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: 05/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025

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 3

Control Number 29-AS-20250425111303

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: 05/02/2025

NARRATIVE

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(continued from LIC9099)

to focus more on R1's room as R2 used to be R1's roommate. The administrator stated he told staff that once R1 was not in their room they could block the door utilizing the spare bed in the room so R2 could not enter. However, R2 figured out how to get around the blockade by entering the adjacent room and going through the Jack and Jill bathroom. They decided to stop blocking the door and they have not used the bed to block the door since that started happening. Staff stated now they keep a closer eye on R2 and redirect R2 when necessary. R2 also takes their current roommate's property and tries to pack it up. Staff keep most of the property belonging to R2's current roommate stored across the hall in the locked laundry area.

Based on interviews with staff, R1's shoe laces were observed to be wrapped around part of the foot rest on R1's wheelchair. R1's visitor had reported to staff they had observed this on more than one occasion. On the day R1's visitor reported this, Staff 2 (S2) took a photo of R1's shoes secured to each foot rest. The staff who were interviewed stated they observed this happened after Staff 1 (S1) had provided R1 with care and before the next shift provided care to R1. S1 stated in the interview that they had not noticed R1's shoe laces around the foot rest and thought it may have happened accidentally. However, the administrator stated he spoke with S1 and S1 initially stated they did not know how it happened but later in a second conversation with administrator admitted to securing R1's laces to the wheelchair foot rests.

Based on these interviews, the above noted allegations are 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: 05/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20250425111303

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: 05/02/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/09/2025 Section Cited CCR 87608(a)(5)	1 2 3 4 5 6 7	87608 Postural Supports (a) (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator already told staff they cannot tie resident's feet to the wheelchair. Administrator will provide training regarding postural supports to all staff and provide evidence of training by 5/9/2025.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply with the section cited above as S1 tied/secured R1's feet to the wheelchair, which poses an immediate health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
Type B 05/09/2025 Section Cited CCR 87468.1(a)(2)	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: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.	1 2 3 4 5 6 7	Administrator has already told staff not to block R1's door with furniture, keep an eye on R2 and redirect R2 when needed. Administrator will conduct personal rights training with staff and provide evidence of training by 5/9/2025.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply with the section cited above as staff did not prevent R2 from entering R1's room and blocked R1's entry to their room, which poses an immediate health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14

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: 05/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025

LIC9099 (FAS) - (06/04)

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