565850243-12-15-2023-29-AS-DPEA-CYQNVV-20231221094831

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850243
Report Date: 12/15/2023
Date Signed: 12/15/2023 09:50:42 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
08/23/2023 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20230823120427

FACILITY NAME:	LAUREL HEIGHTS		FACILITY NUMBER:	565850243
ADMINISTRATOR:	RONDA WILKIN		FACILITY TYPE:	740
ADDRESS:	13960 PEACH HILL DRIVE		TELEPHONE:	(805) 292-0700
CITY:	MOORPARK	STATE: CA	ZIP CODE:	93021
CAPACITY:	112	CENSUS: 59	DATE:	12/15/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Johnny Ortiz		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility has mold.
Facility is in disrepair.
Staff do not ensure kitchen is clean.
Staff are feeding residents food that is not of good quality.
Staff dispensed incorrect medication to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Martha Arroyo conducted a subsequent complaint visit to deliver final findings for the above allegations. The initial visit was conducted on 08/31/2023 and a subsequent visit was conducted on 12/05/2023 by LPA M. Arroyo. On today’s visit, LPA Arroyo met with Executive Director, Johnny Ortiz and the reason for the visit was explained. Entrance Interview.

During the initial visit on 08/31/2023, LPA Arroyo conducted a plant tour to ensure there are no health and safety concerns at 1:23 p.m., observed resident bedrooms at 1:28p.m., toured the kitchen and food area at 1:35 p.m., conducted a medication audit at 1:58 p.m., conducted interviews with five staff and five residents between 1:15 p.m. and 3:18 p.m., and obtained copies of pertinent documents. On 12/05/2023, LPA Arroyo conducted a plant tour at 1:10 p.m., toured and inspected the kitchen/food area at 1:15 p.m., and interviewed the Executive Director beginning at 1:12 p.m. and throughout the plant tour.

(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: 12/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023

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 4

Control Number 29-AS-20230823120427

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: LAUREL HEIGHTS	FACILITY NUMBER: 565850243
	VISIT DATE: 12/15/2023

NARRATIVE

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(Report Continued from LIC 9099...)

It was alleged that facility has mold. It was reported that there is an issue with mold in the basement as well as certain resident bedrooms. During the plant tour on 08/31/2023, LPA observed the basement and specific bedrooms throughout the facility. Upon observation, the LPA did not see any signs of mold on the bedroom walls, behind, or around the bathroom doors. Additionally, there was no smell that indicated there is a mold problem in the facility. Information obtained and reviewed revealed the facility had a leak due to heavy storms; however, the facility had Nu-Cal Pipeline Corp. come out to the facility and do water intrusion repairs where needed. Interviews conducted with staff also indicated the facility had water damage due to water from the rain getting through the walls. Additionally, certain services are provided and offered to residents in the basement which include the salon, movie theater, and fitness center. Interviews conducted with random residents revealed they often visit the basement to take advantage of the services offered downstairs and they did not report smelling mold while being in the basement. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “facility has mold”. Therefore, this allegation is deemed Unsubstantiated at this time.

It was also alleged that facility is in disrepair. It was reported that the stairwell leading to the basement is detaching from the foundation and the stairs shift when in use. Document review revealed the facility had contracting company Nu-Cal Pipeline Corp. do water intrusion repairs due to heavy rains that had caused water damage at the facility. The facility had the pipes sealed, walls, and baseboards replaced. Additionally, during the plant tour on 08/31/2023 and 12/05/2023, the stairwell leading to the basement did not move or shift while the LPA and staff went downstairs. Interviews conducted with staff revealed that neither residents nor family members have reported the facility being in disrepair. Based on LPA observations and record review, the Department does not have sufficient evidence to support the allegation of “facility is in disrepair”. Therefore, this allegation is deemed Unsubstantiated at this time.

It was also alleged that staff do not ensure kitchen is clean. It was reported that the kitchen staff leave the kitchen unkempt, dirty dishes piled up, food that needs to be refrigerated is being left out, and counters are left dirty. During the plant tour on 08/31/2023 and 12/05/2023, the LPA toured both the kitchen and food service area.

(Report Continued on LIC 9099C...)

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20230823120427

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: LAUREL HEIGHTS	FACILITY NUMBER: 565850243
	VISIT DATE: 12/15/2023

NARRATIVE

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(Report Continued from LIC 9099C...)

The LPA observed clean and newly washed dishes on a cart. The sink was empty as all dishes had been recently washed. Kitchen counters appeared clean at the time of the visit. Additionally, all food was observed inside both the refrigerator and freezer and not laying on any counter. Furthermore, interviews conducted with staff revealed that the kitchen is cleaned immediately after all meal services and maintained clean throughout the day. Based on LPA observations, the Department does not have sufficient evidence to support the allegation of “staff do not ensure kitchen is clean”. Therefore, this allegation is deemed Unsubstantiated at this time.

It was also alleged that staff are feeding residents food that is not of good quality. It was reported that chunky milk that has been expired is left in the refrigerator and expired food is being served to the residents. During the facility walkthrough on 08/31/2023, the LPA observed the facility’s food supply in the kitchen, pantry, and refrigerator. The LPA observed food from all groups such as meats, dairy, eggs, breads, fresh fruit, and vegetables. Additionally, the LPA inspected the food labels and checked for expiration dates. All food labels had dates clearly marked and no expired food was observed. Interviews conducted with staff revealed the facility’s food is usually ordered to be delivered twice a week and perishables are ordered as needed. Interviews conducted with random residents revealed the food prepared at the facility is better than other places they have been to. Furthermore, residents reported to LPA during interviews that the facility offers a variety of different foods, they had no concerns about the food being served at the facility. Based on LPA observation and interviews conducted, the Department does not have sufficient evidence to support the allegation of “staff are feeding residents food that is not of good quality”. Therefore, this allegation is deemed Unsubstantiated at this time.

It was further alleged that staff dispensed incorrect medication to resident. It was reported that one resident’s half pill was found in another resident’s bedroom. During the visit on 08/31/2023, LPA conducted a medication audit for four (4) random residents and no discrepancies were observed. Review of centrally stored medication and destruction records indicate medications are being administered as prescribed. Interviews conducted with staff revealed medication audits are performed to maintain accuracy and make sure medication is being administered correctly to residents.

(Report Continued on LIC 9099C...)

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20230823120427

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: LAUREL HEIGHTS	FACILITY NUMBER: 565850243
	VISIT DATE: 12/15/2023

NARRATIVE

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(Report Continued from LIC 9099C...)

Additionally, staff stated medication technicians are trained before they are able to assist residents with medications. Interviews conducted with random residents revealed that their medication is administered by staff around the same time every day and reported having no issue with their medications while living at the facility. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “staff dispensed incorrect medication to resident”. Therefore, this allegation 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: 12/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023

LIC9099 (FAS) - (06/04)

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