565850093-5-17-2022-29-AS-KHEN-CETQAG-20220527115955

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850093
Report Date: 05/17/2022
Date Signed: 05/17/2022 04:07:28 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
03/18/2022 and conducted by Evaluator Angel Ascencio

COMPLAINT CONTROL NUMBER: 29-AS-20220318084413

FACILITY NAME:	VENTURA VILLA ASSISTED LIVING		FACILITY NUMBER:	565850093
ADMINISTRATOR:	WARD-MICHAYLUK, EVANGELINE		FACILITY TYPE:	740
ADDRESS:	3482 LOMA VISTA ROAD		TELEPHONE:	(805) 644-1292
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	49	CENSUS: 18	DATE:	05/17/2022
		UNANNOUNCED	TIME BEGAN:	01:02 PM
MET WITH:	Endy Guadarrama		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Facility failed to meet the needs of the residents
Facility has insufficient staffing

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angel Ascencio conducted an unannounced subsequent visit to deliver the final findings to the above facility. LPA met with Administrative Assistant Endy Guadarrama at 1:02 p.m. Administrator Evangeline Michayluk is unavailable due to family emergency. Entrance interview conducted.

The Woodland Hills North Regional Office (RO) received a complaint on 03/18/2022 alleging that facility staff are failing to meet the needs of the residents and facility has insufficient staffing. On 03/23/2022 LPA Ascencio conducted staff interviews starting at 12:40 PM. During the staff interviews, it was revealed that they always work a four-two-four (4-2-4) schedule with 2 staff members scheduled daily. Further interviews revealed that the facility is using an outside agency ACE Compassionate Care, to assist when staffing needs are low.

Continued on LIC 9099 - C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

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-20220318084413

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 VILLA ASSISTED LIVING	FACILITY NUMBER: 565850093
	VISIT DATE: 05/17/2022

NARRATIVE

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LPA Ascencio received February and March 2022 staffing schedule. Review of the schedules revealed that there has been 2 staff members for the 1^st shift (7:00 a.m. – 3:00 p.m.), 2 staff members for the 2^nd shift (3:00 p.m. – 11:00 p.m.) and 2 staff members for the 3^rd shift (11:00 p.m. – 7:00 a.m.). Further staff interviews also revealed that Resident #1 (R1) moved in early March 2022 and has had a hard time adjusting to the facility. When R1 moved in, they would wander within the community screaming and yelling for help. Staff would intervene and attempt to redirect with some days more successful than others. Continued staff interviews also revealed that they have cameras throughout the facility and when R1 yells for help, they notice on the cameras that R1 is not in any immediate danger. Further staff interviews also revealed that staff use various methods of interventions to redirect R1 including a calm demeanor, creative verbal responses and meaningful activities. One of the last interventions for R1 is the use of medication, which they are prescribed for agitation. Interview with R1 starting at approximately 2:10 p.m. on 03/23/2022 revealed that they like the place they currently live at. R1 also mentioned that they do not have a problem with any staff or residents in the facility. Further interview with R1 also revealed that they do not yell for help, they just let the staff know what they need and that the staff are good and treat them nice.

Based on file review and staff and resident interviews, the allegations; Facility failed to meet the needs of the residents and facility has insufficient staffing are deemed Unsubstantiated at this time.

Exit interview conducted and copy of the report provided to admin via email.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

LIC9099 (FAS) - (06/04)

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