565850067-6-15-2023-29-AS-DPEA-CX55UX-20231030201637

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850067
Report Date: 06/07/2023
Date Signed: 06/15/2023 09:46:14 AM

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
06/17/2022 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20220617151723

FACILITY NAME:	VISTA AT SIMI VALLEY		FACILITY NUMBER:	565850067
ADMINISTRATOR:	CAROL ANN LEROSE		FACILITY TYPE:	740
ADDRESS:	1236 ERRINGER ROAD		TELEPHONE:	(805) 351-8802
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY:	130	CENSUS: 82	DATE:	06/07/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Brimen Vivar		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff not responding timely to resident's call button
Residents room air conditioner runs too cold during cool day's/night's

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint visit to deliver findings regarding the above noted allegations. LPA initially met with executive director Maddi Lewis and explained the reason for the visit. At 11:00 a.m. LPA met with administrator Brimen Vivar and discussed complaint findings.

On 6/24/2022, LPA conducted interviews with the previous Executive Director at 11:08 a.m., with the maintenance director at 11:37 a.m., and the previous resident care director at 1:04 p.m. LPA conducted an inspection of residents' room at 11:44 a.m. LPA reviewed and obtained pertinent records at 1:26 p.m.

(continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

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-20220617151723

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: VISTA AT SIMI VALLEY	FACILITY NUMBER: 565850067
	VISIT DATE: 06/07/2023

NARRATIVE

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(continued from 9099)

Regarding Resident's room is too hot/cold due to the HVAC thermostat:
LPA interviewed the maintenance director regarding the HVAC system. He stated the HVAC system was working as designed but the residents get confused on how to operate the thermostats. Residents 1 and 2 (R1) (R2) were in a room which had two thermostats; one for the main living area and one for the bedroom. R1 preferred the room warmer than R2. On 6/24/2022, LPA inspected the room and found it to be quite warm. LPA asked R2, who was sitting in the living room, if they were comfortable with the temperature and R2 confirmed they liked the temperature. R1 was resting in the bedroom where it was even warmer. R1 stated they preferred the temperature on the warmer side. Currently R1 resides in the facility alone and prefers to keep the temperature at 78*F. The maintenance director and R1's representative have worked things out to where the representative is able to change the temperature of the room remotely from home if R1 calls the representative complaining about the temperature. Based on observations and interviews, the allegation resident's room is too hot/cold due to the HVAC thermostat is deemed Unsubstantiated at this time.

Staff not responding timely to residents' call buttons
LPA interviewed R1 and R2 on 6/24/2022. They stated usually staff respond timely to their pendant calls. They stated they also call their family if they need help with their thermostat. LPA had requested pendant call records for June 2022 but the administrator was unable to obtain those records. Based on interviews with residents, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report and appeal rights were provided to the administrator.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC9099 (FAS) - (06/04)

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