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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850367
Report Date: 12/13/2023
Date Signed: 12/13/2023 03:19:08 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
12/11/2023 and conducted by Evaluator Elsie Campos
COMPLAINT CONTROL NUMBER: 29-AS-20231211170326
FACILITY NAME:COLONY OF THOUSAND OAKS AT SIDLEE EAST INCFACILITY NUMBER:
565850367
ADMINISTRATOR:AGGARWAL, RASHITAFACILITY TYPE:
740
ADDRESS:415 EAST SIDLEE STREETTELEPHONE:
(805) 418-7514
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:6CENSUS: 5DATE:
12/13/2023
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Connie RoushTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility staff was unable to hear residents calls for assistance
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elsie Campos conducted an unannounced initial 10-day complaint visit. The LPA met with staff and Administrator Connie Roush and explained the reason for the visit.

During today’s visit, the LPA, conducted a physical plant tour at 10:20 a.m., interviewed staff at 10:30 a.m. and 10:48 a.m. and 11:45 a.m., interviewed administrator at 10:44 a.m., and interviewed residents at 10:38 a.m., 11:15 a.m. and 11:25 a.m.

Regarding the allegation: Facility staff was unable to hear residents calls for assistance.

It was alleged that facility staff was unable to hear residents calls for assistance. A credible witness noted that at the time of the visit there a was only one caregiver in the living room area which is not centrally located in the home and would not have allowed staff to hear verbal calls from residents on opposite side of home should they have a care need or emergency. ** Continued on LIC 9099-C**
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Elsie Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
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-20231211170326
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: COLONY OF THOUSAND OAKS AT SIDLEE EAST INC
FACILITY NUMBER: 565850367
VISIT DATE: 12/13/2023
NARRATIVE
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Upon the LPA’s observation of the living room, kitchen and dining area it was observed that the areas are in the middle of the home, upon entry into the facility you enter the living room right away and directly adjacent to the living room is the kitchen and dining room. LPA observed that there is one main hallway to the left of the living room with resident rooms and one resident room located in a smaller hallway next to the kitchen. Staff interviews confirmed that both hallways are frequented by staff throughout the day and that staff can hear residents calls as the common areas are centrally located. Furthermore, staff confirmed that those residents that have call buttons can use them and those that do not are checked on continuously throughout the day and night. Staff did not reveal any concerns with hearing residents. At the time of the visit the LPA was able to hear the call button notification in the living room and common areas when pressed. Resident interviews did not reveal concerns with staffing or staff meeting their care needs as they are able to call staff for assistance or staff will come around and check on them throughout the day. Resident interviews confirmed that staff are attentive to their needs and calls for assistance are met in a timely manner. Based on the evidence obtained, there is insufficient evidence to support the claim that facility staff was unable to hear residents calls for assistance. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Elsie Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
LIC9099 (FAS) - (06/04)
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