565850186-3-22-2023-29-AS-DPEA-CQDQXF-20230329123327

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850186
Report Date: 03/22/2023
Date Signed: 03/22/2023 03:10:35 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
11/02/2022 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20221102143914

FACILITY NAME:	COTTAGES AT THE COLONY OF THOUSAND OAKS #1		FACILITY NUMBER:	565850186
ADMINISTRATOR:	ROUSH, CONNIE		FACILITY TYPE:	740
ADDRESS:	189 VENUS STREET		TELEPHONE:	(818) 479-3700
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	6	CENSUS: 5	DATE:	03/22/2023
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Connie Roush		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Illegal drugs on the premises – Facility staff using methamphetamine at the facility.
Staff falsify the residents’ medication logbooks

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to deliver findings for the above allegations. LPA met with staff Rea Leon Guerrero and Carlo Garcia. Administraotr was contacted and arrived to facility at approximately 2:25pm. Reason for visit was explained.

On 11/02/2022, the Department received a complaint regarding an allegation of illegal drugs on the facility premises. It was alleged that Facility staff were using methamphetamine at the facility. The complaint was referred to Community Care Licensing Investigations Branch (IB) and assigned to Investigator Douglas Real.

On 11/03/2022, from 1:30pm to 5:30pm, Licensing Program Analyst (LPA) Zabel Chochian conducted an unannounced initial complaint visit. LPA Chochian met with the Administrator and explained the reason for the visit. During the visit, the LPA conducted a physical plant tour at 1:30pm and reviewed and obtained pertinent documents starting at approximately 2:00pm. (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: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

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-20221102143914

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: COTTAGES AT THE COLONY OF THOUSAND OAKS #1	FACILITY NUMBER: 565850186
	VISIT DATE: 03/22/2023

NARRATIVE

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The LPA informed the Administrator that the complaint allegation was assigned to the Community Care Licensing (CCL) Investigations Branch (IB) and assigned to Investigator Douglas Real.

On 11/14/2022, Investigator Real conducted interviews with facility staff and residents. None of the residents had any problems or concerns to report. None have witnessed any drug use by anyone in the facility and none have seen anyone smoke in the facility. The facility staff denied the allegation.

Based on the information obtained, the investigation did not provide sufficient evidence to support the allegation. Therefore, the allegation “Illegal drugs on the premises – Facility staff using methamphetamine at the facility” is deemed Unsubstantiated at this time.

Regarding the allegation: Staff falsify the residents’ medication logbooks. It was alleged that staff falsify the resident’s medication centrally stored log. During todays visit LPA Chochian conducted a medication audit for three (3) out of five (5) residents at approximately 2:30pm. The medication audit revealed no discrepancies at this time. The allegation of staff falsify the residents’ medication logbooks is deemed Unsubstantiated at this time.

Exit interview conducted, 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: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC9099 (FAS) - (06/04)

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