565850217-8-8-2024-29-AS-KHEN-D8M7LW-20240829214614

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850217
Report Date: 08/08/2024
Date Signed: 08/08/2024 01:17:58 PM

Substantiated

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
06/12/2024 and conducted by Evaluator Kelly Dulek

COMPLAINT CONTROL NUMBER: 29-AS-20240612094331

FACILITY NAME:	WE CARE SENIOR FACILITY LLC		FACILITY NUMBER:	565850217
ADMINISTRATOR:	HORDAGODA, SHASHIKA		FACILITY TYPE:	740
ADDRESS:	3350 EL NIDO ST		TELEPHONE:	(818) 571-1905
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93010
CAPACITY:	6	CENSUS: 5	DATE:	08/08/2024
		UNANNOUNCED	TIME BEGAN:	08:12 AM
MET WITH:	Shashika Hordagoda		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Conduct Inimical: Staff are committing fraud against resident
Staff do not treat resident(s) with dignity and respect

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Kelly Dulek and Teresa Camara conducted a subsequent complaint investigation for the allegations listed above. LPAs arrived at the facility unannounced at 08:12AM and contacted the licensee via telephone. Licensee arrived at the facility shortly after the visit began. Entrance interview conducted.

During today's visit, LPAs interviewed staff and residents throughout the visit. During the initial complaint visit which took place on 06/19/2024 beginning at 09:37AM, LPAs spoke with Licensee/Administrator, reviewed and obtained copies of pertinent documents, toured the facility with facility staff at 10:35AM. Throughout the course of the investigation, LPAs reviewed copies of documents and interviewed other relevant parties. The following was then determined:

Report Continued on LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024

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 3

Control Number 29-AS-20240612094331

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: WE CARE SENIOR FACILITY LLC	FACILITY NUMBER: 565850217
	VISIT DATE: 08/08/2024

NARRATIVE

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Allegation: "Conduct Inimical: Staff are committing fraud against resident:"

The complaint alleges that facility staff are making unauthorized charges from Resident #1 (R1)'s bank account. LPAs reviewed bank records for R1, which indicated that one unauthorized check was written in the amount of $1940 referenced the name of Staff #1 (S1). Additional charges on the account totaling in excess of $12,000 were also disputed and reflect the names of S1 as well as Staff #2 (S2) and another user not associated to the facility. Interview with R1 revealed that R1 did not authorize these charges and the charges were reviewed by R1's financial institution, confirming fraudulent activity. During today's visit, Ventura County Sheriff Office (VCSO) officers and detectives were present at the facility. VCSO interviewed both S1 and S2. Following the interviews, S2 was arrested and escorted from the facility. Based on interview and record review, there is sufficient evidence to support the allegation; therefore the allegation "conduct inimical: staff are committing fraud against a resident" is deemed SUBSTANTIATED at this time.

Allegation: "Staff do not treat resident(s) with dignity and respect:"

The complaint also alleges that staff are rough with the residents. Interview with facility residents revealed that one resident heard another resident state "don't hit me" while care was being provided to that resident. Additional residents interviewed indicated that staff are rough when providing care and residents reported not feeling safe due to changes in staff's mood. Residents interviewed also indicated that staff yell at residents. Based on interview, there is sufficient evidence to support the allegation, therefore the allegation "staff do not treat resident(s) with dignity and respect" is deemed SUBSTANTIATED at this time.

The following deficiencies were observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. A copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240612094331

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: WE CARE SENIOR FACILITY LLC	FACILITY NUMBER: 565850217
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/08/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/08/2024 Section Cited HSC 1569.58(a)(2)	1 2 3 4 5 6 7	§1569.58(a)(2) Engaged in conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility, or the people of the State of California. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to fully cooperate with ongoing law enforcement investigation and to keep CCL informed of any relevant updates. Licensee also understands that S2 cannot return to the facility. Licensee agrees to comply with a non compliance visit at the Regional Office.
	8 9 10 11 12 13 14	Based on record review and interviews, facility staff was engaged in fraudulent activity with R1's financial accounts and staff was arrested for such activities, which poses an immediate personal rights risk to residents in care.	8 9 10 11 12 13 14
Type A 08/09/2024 Section Cited HSC 87468.1(a)(1)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee agreed to provide vendorized personal rights training to staff and provide proof of training to CCL. Training will be scheduled and date communicated to CCL by POC due date. Proof of training will be provided to CCL upon completion.
	8 9 10 11 12 13 14	Based on interview, residents report staff handling them rough and yelling at the residents, which poses an immediate personal rights risk to persons in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024

LIC9099 (FAS) - (06/04)

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