565850141-2-24-2023-29-AS-DPEA-CQ4SPX-20230320140352

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850141
Report Date: 02/24/2023
Date Signed: 02/24/2023 10:24:24 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
09/22/2022 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20220922164050

FACILITY NAME:	AEGIS LIVING VENTURA		FACILITY NUMBER:	565850141
ADMINISTRATOR:	KAREN G GOROYAN		FACILITY TYPE:	740
ADDRESS:	4964 TELEGRAPH ROAD		TELEPHONE:	(805) 650-1114
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	100	CENSUS: 81	DATE:	02/24/2023
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Mary Sawyer		TIME COMPLETED:	10:35 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff not meeting the needs of the resident in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegation. The initial visit was conducted on 09/29/2022 by LPA M. Arroyo. On today’s visit, LPA Arroyo met with Marketing Director, Mary Sawyer as the Executive Director was unavailable. Entrance interview conducted.

During the initial visit on 09/29/2022, LPA Arroyo conducted a tour of the facility at 11:48 a.m., conducted interviews with the Executive Director, four staff, and seven residents between 11:45 a.m. and 1:00 p.m., and conducted a resident file review and obtained copies of resident records and other pertinent documents at 1:05p.m. On 02/21/2023, LPA conducted telephonic interviews with Resident #1's (R1's) family at 11:07 a.m. and 11:22 a.m.

Report Continued on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

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 2

Control Number 29-AS-20220922164050

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: AEGIS LIVING VENTURA	FACILITY NUMBER: 565850141
	VISIT DATE: 02/24/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Report Continued from LIC 9099...

It was alleged that facility staff is not meeting the needs of the resident in care. The Reporting Party (RP) reported observing R1 hanging off the bed, cancer wound leaking, thirsty, and eyes closed shut due to eye discharge. A review of R1’s Physician’s Report (LIC 602A) dated 06/28/2022, indicated R1 required an extensive one person assist as well as needing assistance with oral administration. However, LIC 602A also noted R1 to be able to follow instructions, able to communicate needs, and able to feed self. Interviews with random residents revealed staff are quick to respond when they are called and stated they have also observed staff throughout the facility assisting residents. Additionally, residents reported staff coming into their rooms throughout the day to check on them, assist to bring them down to the dining room during meals, and assist with administration of medications as needed. Interviews with staff also revealed residents are checked every couple of hours throughout the day and night and if any resident requests assistance they are ready to help. Furthermore, interviews conducted with R1’s family revealed having no concerns with how the staff was treating R1 as well as how they were caring for R1. R1’s family stated they felt R1 was getting the care they needed by the staff at the facility. Based on all the information gathered during the course of the investigation, the above allegation, “facility staff not meeting the needs of the resident in care” is deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued. Report was reviewed and a copy was issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2