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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802472
Report Date: 12/29/2022
Date Signed: 12/29/2022 03:37:38 PM

Substantiated


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
09/01/2022 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20220901150521
FACILITY NAME:VENTURA GRAND CHATEAUFACILITY NUMBER:
565802472
ADMINISTRATOR:MARK DEN PERALTAFACILITY TYPE:
740
ADDRESS:5430 TELEGRAPH ROADTELEPHONE:
(805) 642-2567
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:49CENSUS: 35DATE:
12/29/2022
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Sean Beharry, Backup AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility is unsanitary.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Olson conducted an unannounced complaint visit to issue final findings. LPA Dulek conducted the initial investigation and conducted interviews with staff and residents on 09/06/22. LPA Olson made a subsequent visit on 12/07/2022 and interviewed Administrator and requested pertinent documents. LPA Olson reviewed records and interviewed staff on 12/7/22, 12/21/22, 12/22/22, and 12/23/22. During today’s visit, LPA Olson met with Sean Beharry, Backup Administrator and explained the reason for the visit.

On the allegation: Facility is unsanitary. It was alleged that Resident 1 (R1)’s living space is extremely unclean and R1’s responsible parties scrubbed the floors themselves. Interview with staff on 9/6/22 revealed R1’s family stated the floor was filthy. LPA interviewed 8 staff. Interviews revealed there was a dark film on the floor from build up from the Mop & Glo cleaner the facility staff use to clean. The residue built up looked discolored and was sticky. Staff stated it has since been scraped off and a new cleaning solution is being used. Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
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 5
Control Number 29-AS-20220901150521
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: 12/29/2022
NARRATIVE
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There is a housekeeper scheduled in the morning who cleans regularly. On 9/6/22 LPA Dulek took pictures of one of the bathroom floors which was observed to have black buildup in part of the grout near the toilet, sink and white buildup in the grout in the shower. On 12/7/22 LPA Olson observed R1’s living area to be clean and the bathrooms to be adequate. LPA Olson interviewed Staff 2 (S2) who is a housekeeper/ caregiver on 12/7/22. S2 stated that all bathrooms are cleaned twice per shift with a cleaning agent similar to Pine sol and Fabuloso. LPA interviewed R1’s Responsible Party on 12/21/22 who stated the film that was on the floor was dark and sticky and it had taken staff a while to finally remove it. LPA Olson interviewed multiple staff who mostly stated it is too much for one housekeeper to clean the facility and everyone needs to pitch in to do their part. Staff stated the facility could be better maintained and needs at least 2 people on shift to clean and to make ensure rooms are deep cleaned once a week. Many staff stated they don’t feel the facility is as clean as it should be and clean the resident rooms themselves. Based on observation and interviews, this allegation is deemed Substantiated at this time.

Exit interview conducted, Deficiencies cited (9099-D), copy of Appeal rights and report emailed.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20220901150521
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: 12/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/05/2023
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced:
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Administrator agreed to deep clean all rooms and bathrooms and send pictures to LPA Olson by 1/5/23.
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Based on observation and interview, the licensee did not comply with the above cited section when the facility was not clean and in good repair, which posed a potential health, safety, and personal rights risk to residents 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: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
09/01/2022 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20220901150521

FACILITY NAME:VENTURA GRAND CHATEAUFACILITY NUMBER:
565802472
ADMINISTRATOR:MARK DEN PERALTAFACILITY TYPE:
740
ADDRESS:5430 TELEGRAPH ROADTELEPHONE:
(805) 642-2567
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:49CENSUS: 35DATE:
12/29/2022
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Sean Beharry, Backup AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not keep facility free of scabies.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Olson conducted an unannounced complaint visit to issue final findings. LPA Dulek conducted the initial investigation and conducted interviews with staff on 09/06/22. LPA Olson made a subsequent visit on 12/07/2022 and interviewed Administrator and requested pertinent documents. LPA Olson reviewed records and interviewed staff on 12/7/22, 12/21/22, 12/22/22, and 12/23/22. LPA Olson interviewed the Nurse Practionoer on 12/22/22 and a Dermatologist on 12/23/22.

On the allegation: Staff did not keep facility free of scabies. It was alleged that R1 is a hospice patient and was treated for their second round of scabies and the diagnosis was confirmed by a physician. Staff and responsible party interviews revealed R1 had a rash and was diagnosed with scabies by their primary physician and prescribed medication. Staff 1 stated there were two other residents treated for Scabies at the time, Resident 2 (R2) and Resident 3 (R3). R2’s treatment didn’t work and was later diagnosed with Grover’s Disease by a dermatologist. R3 had a confirmed skin scrape of Scabies.
Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
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 5
Control Number 29-AS-20220901150521
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: 12/29/2022
NARRATIVE
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Administrator stated they hired a Dermatologist to come observe residents’ skin every 6 months. A dermatologist had just come on 12/10/2022 and S1 stated residents got a new cream and are finally starting to improve. Interviews revealed that the facility recently had a resident with suspected Scabies and most residents were treated with cream. The only residents who were not treated were patients of a particular medical insurance group who did not approve the order of the treatment. LPA interviewed staff who stated that when a resident has suspected scabies, they remove all the linen and wash everything in hot water. LPA Olson interviewed Staff 2 (S2) on 12/7/22 who stated that they collected all resident’s bedding and clothes and took it to a local laundry mat and washed everything in hot water with hypoallergenic soap. Multiple staff interviewed stated they have been itchy and have dots on their body, but doctor’s have said it was dermatitis. Administrator and staff said the facility has done multiple things to try and decrease the rashes and itching such as test the water, the facility changed the laundry soap, changed companies that washes the bedding, and looked a into water softener. LPA Olson spoke with the Nurse Practitioner (NP) who oversees 10 residents who reside in the facility. NP stated that they had worked closely with the lead MedTech to try and remedy the situation. NP felt that the facility has tried everything and is willing to work to do anything to prevent the spread of scabies and fight the dermatitis. LPA Olson interviewed the Dermatologist (D1) who visited the facility on 12/10/2022 and saw 18 residents. The Dermatologist stated they did not observe any scabies and they had no concerns about the residents or their skin condition. D1 stated the residents looked healthy and well cared for and residents were diagnosed with senile atopic dermatitis which, according to D1, means that the resident’s skin is dry due to being older and not producing as much oil. D1 felt it was not due to anything that the facility did or didn’t do. Based on observation and record review the allegation is deemed Unsubstantiated at this time.

Exit interview conducted, copy of the report was emailed.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5