565850067-8-29-2024-29-AS-DPEA-D8MT7V-20240830142922

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850067
Report Date: 08/28/2024
Date Signed: 08/29/2024 01:04:57 PM

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
02/13/2024 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20240213083220

FACILITY NAME:	VISTA AT SIMI VALLEY		FACILITY NUMBER:	565850067
ADMINISTRATOR:	VIVAR, BRIMEN		FACILITY TYPE:	740
ADDRESS:	1236 ERRINGER ROAD		TELEPHONE:	(805) 351-8802
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY:	130	CENSUS: 93	DATE:	08/28/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Madison Lewis, Managing Director		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff did not address resident's change in health condition
Staff did not take precautions to prevent a scabies outbreak

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to the facility. The purpose of the visit is to deliver investigation finding. Upon arrival LPA met with Madison Lewis, Managing Director and explained the reason for the visit. Allegation finding were discussed.

On 02/13/2024, Community Care Licensing Division received the above complaint allegations. Investigation into the allegations consist of records review, interview with staff, and random residents on 02/16/2024, from approximately 4pm-6pm. Other potential witnesses were contacted on 8/19/2024.

Following is a summary of the allegations and investigation finding:
Allegations) “Staff did not address resident’s change in condition and Staff did not take precautions to prevent a scabies outbreak”: It was reported that the facility did not address resident #1 (R1) excessive skin dryness and did not take precautions to prevent a scabies outbreak. It was also reported that R1 was tested positive for scabies. (Continue to LIC9099c).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

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-20240213083220

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: 08/28/2024

NARRATIVE

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It is alleged that the resident has had scabies for some time and was highly contagious. Interviews conducted with facility staff and records reviewed revealed that on 02/03/2024, ambulance was called for R1 due to an unusual, altered status and distress.

Staff interviewed and records reviewed confirmed that R1 was evaluated by a physician on 01/17/2024 for the skin dryness and was not noted as scabies. Staff reported that they did not have any other resident with any skin issues. Staff interviewed reported that R1 was in the hospital for a week and was discharged on 02/07/2024 to a rehab-facility and was cleared to return to the facility on 03/16/2024. Staff denied having any scabies outbreak at the facility and reported that R1 was regularly observed, and any changes were communicated to the family and doctor timely. Seven (7) out of seven residents interviewed including R1 did not report any care issues at this time.

Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation that “Staff did not address resident's change in health condition and Staff did not take precautions to prevent a scabies outbreak”. Therefore, the allegations is deemed UNSUBSTANTIATED at this time.

Exit interview conducted and copy of report provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

LIC9099 (FAS) - (06/04)

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