565850141-12-30-2024-29-AS-KLOZ-DCG98B-20241230220827

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850141
Report Date: 12/30/2024
Date Signed: 12/30/2024 02:45:15 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
12/15/2023 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20231215145245

FACILITY NAME:	AEGIS LIVING VENTURA		FACILITY NUMBER:	565850141
ADMINISTRATOR:	LANCE SHENK		FACILITY TYPE:	740
ADDRESS:	4964 TELEGRAPH ROAD		TELEPHONE:	(805) 650-1114
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	100	CENSUS: 82	DATE:	12/30/2024
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	J.P. Rollet -Acting Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff are not properly caring for the residents
Staff are not checking on residents during the night
Staff took away residents medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced subsequent complaint visit for the above allegations. Upon arrival, LPA met with Genral Manager John Washko, and was explained the reason for the visit. Entrance interview conducted. Acting administrator J.P. Rollet arrived shortly thereafter and was explained the reason for the visit.

On 12/22/2023, between 01:30 p.m. and 3:30 p.m., the LPA interviewed the Executive Director, three (3) residents, conducted a resident file review and obtained copies of resident records and other pertinent documents relevant to the investigation. During today's visit the LPA conducted a file reiew, three (3) resident, six (6) staff interviews and interviewed R1's family member. Report will continue on LIC9099-C, 2nd page.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024

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-20231215145245

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: AEGIS LIVING VENTURA	FACILITY NUMBER: 565850141
	VISIT DATE: 12/30/2024

NARRATIVE

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On the allegations, “Staff are not properly caring for the residents, and Staff are not checking on residents during the night,”; it is the concern of the reporting party that staff are not checking on Resident 1 (R1) during the night and staff do not know what is wrong with R1 therefore do not provide proper care. Interviews with random residents revealed that they do not have any concerns with the care being provided and staff check on them frequently including during the night. Interviews conducted with staff revealed that they believe they provide adequate care to all residents. Residents are checked every two (2) hours throughout the day and night however it depends on each residents care plan, some residents may be checked on every hour, and if any resident requests assistance they are ready to help. Staff from all shifts including the NOC shift revealed that R1 was frequently checked on and would press their pendant quite often. Additionally, staff revealed that they have access to the resident’s care needs plan and if there’s ever a time, they are not knowledgeable regarding something in the resident’s care needs plan, they will call their care lead or nurses to be able to assist the residents. Furthermore, interviews conducted with R1’s family revealed they had no concerns with the care provided to R1. R1’s family stated that staff have gone out of their way to assist R1. Based on all the information gathered during the course of the investigation, the above allegations, are deemed Unsubstantiated at this time.

On the allegation, “Staff took away residents’ medication”; it is the concern of the reporting party (RP) that staff took away Resident 1’s (R1’s) medications. RP did not provide additional information. To investigate the allegation the LPA conducted interviews and file review. Staff revealed that R1 had always been under medication management and could not have access to medication, therefore staff would need to confiscate medication from R1. A review of R1’s Physician’s Report (LIC602A), dated 07/25/2023, indicated R1 is not able to administer or store their own prescription and PRN medications. Based on interviews and file review the above allegation is deemed Unsubstantiated at this time.

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

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024

LIC9099 (FAS) - (06/04)

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