565850187-3-16-2023-29-AS-DPEA-CQBQ22-20230327114623

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850187
Report Date: 03/16/2023
Date Signed: 03/16/2023 06:31:51 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
08/16/2022 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20220816143803

FACILITY NAME:	451 COLUMBIA LLC		FACILITY NUMBER:	565850187
ADMINISTRATOR:	SHERMAN, GILLIANA		FACILITY TYPE:	740
ADDRESS:	451 COLUMBIA ROAD		TELEPHONE:	(805) 807-0663
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	6	CENSUS: 6	DATE:	03/16/2023
		UNANNOUNCED	TIME BEGAN:	06:15 PM
MET WITH:	Bernardito Suarez		TIME COMPLETED:	06:35 PM

ALLEGATION(S):

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Resident was restrained.

Staff handled resident roughly.

INVESTIGATION FINDINGS:

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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 allegations. The initial visit was conducted on 08/18/2022 by LPA M. Arroyo. On today’s visit, LPA Arroyo met with Administrator, Bernardito Suarez. Entrance interview conducted.

During the initial visit on 08/18/2022, LPA Arroyo conducted a tour of the facility at 9:45 am, conducted interviews with the Licensee, two staff, and four residents between 10:20 am and 11:25 am., and conducted a resident file review and obtained copies of resident records and other pertinent documents relevant to the investigation at 10:00 am. LPA Arroyo also conducted a staff interview on 09/26/2022 at 1:30 pm, and conducted interviews with resident family members on 09/15/2022 at 4:14 pm and 12/20/2022 at 10:53 am.

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: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

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-20220816143803

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: 451 COLUMBIA LLC	FACILITY NUMBER: 565850187
	VISIT DATE: 03/16/2023

NARRATIVE

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Report Continued from LIC 9099...

It was alleged that resident was restrained. It was reported that Resident #1 (R1) was tied to the bed to not get out or slip out of bed. A review of R1’s physician report, dated 07/26/2022, noted R1 is confused, disoriented, and displays inappropriate and aggressive behavior. The report also indicated R1 was not able to bathe, dress/groom, feed, or take care of their toileting needs. Interviews and record review also revealed that during the night, R1 was screaming, yelling, and being combative. However, staff was comforting R1 and making sure they were safe. Additionally, during interviews, staff denied any claims that anyone at the facility has ever restrained a resident to their bed. Correspondingly, family members reported seeing residents move freely throughout the facility while visiting. Interviews conducted with residents revealed they felt safe and reported having no concerns living at the facility. Furthermore, interviews conducted with R1’s family revealed they did not observe any type of bruising on R1’s ankles after discovering the rope tied to the bed. Based on the investigation, there is insufficient evidence to support the claim that resident was restrained. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the above-mentioned claim at the time the complaint was received. Therefore, the allegation is deemed Unsubstantiated at this time.

It was also alleged that staff handled resident roughly. It was reported that upon arrival to the facility, R1 did not want to get out of the car. The staff grabbed R1 and dropped R1 on to the wheelchair. Interviews with residents revealed they have had no concerns while living at the facility. Residents stated staff has always been nice and reported feeling safe while at the facility. Interviews conducted with family members revealed they often visit the residents at the facility and reported never witnessing staff handling any residents aggressively. In addition, family members stated observing how staff treated residents and felt the staff was caring towards everyone. Furthermore, family members stated they had nothing negative to say about the facility and staff. Based on the investigation, there is insufficient evidence to support the claim that staff handled resident roughly. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the above-mentioned claim at the time the complaint was received. Therefore, the allegation is deemed Unsubstantiated at this time.

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

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC9099 (FAS) - (06/04)

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