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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 567609831
Report Date: 01/17/2025
Date Signed: 01/17/2025 02:03:28 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
12/06/2024 and conducted by Evaluator Angela Barutyan
COMPLAINT CONTROL NUMBER: 29-AS-20241206113504
FACILITY NAME:ROYAL OAKS INNFACILITY NUMBER:
567609831
ADMINISTRATOR:JAKOBOVICH, BRANDONFACILITY TYPE:
740
ADDRESS:45 ERBES RDTELEPHONE:
(805) 495-4657
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91362
CAPACITY:80CENSUS: 49DATE:
01/17/2025
UNANNOUNCEDTIME BEGAN:
01:37 PM
MET WITH:Brandon JakobovichTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Licensee does not ensure that infection control practices are maintained
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a subsequent complaint investigation with the purpose of delivering findings for the allegation listed above at 01:37PM. LPA met with Licensee Brandon Jakobovich. Reason for the visit was explained.
During the initial visit on 12/09/2024, LPA conducted a brief physical plant tour, conducted interviews with four (4) staff members, two (2) staff from outside agencies, and three (3) residents, reviewed and obtained copies of pertinent documents relevant to the investigation, and discussed allegation with Administrator Gold and Licensee Jakobovich.
It was alleged that the infection control practices are not maintained at the facility as Resident #1 (R1) contracted possible scabies. The complainant alleges that R1 had chronic skin irritation, believed to be scabies, while residing at the facility which cleared after R1 moved out. Interviews conducted with R1’s responsible parties explained that three (3) members began exhibiting skin irritation symptoms after visiting the facility. Per responsible parties, symptoms of the visitors and R1 cleared after using a Permethrin treatment, a topical medication used to treat scabies and head lice. Report Continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025
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 2
Control Number 29-AS-20241206113504
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: ROYAL OAKS INN
FACILITY NUMBER: 567609831
VISIT DATE: 01/17/2025
NARRATIVE
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However, it was also stated that R1 and other members were seen by multiple doctors, including at least two (2) dermatologists, and that a biopsy of R1’s skin was collected, all of which did not result in a scabies diagnosis. It was further stated that R1’s skin condition differed from the other members and that R1’s skin condition began and ended on the same timeline as one of R1’s medications; responsible parties also speculate that R1’s condition could have been an allergic reaction to the medication used during the same time as the skin condition. Responsible parties further stated that not all visiting members contracted the skin condition that the three (3) members did and that it is still unclear what the skin condition could have been as there were no official diagnoses and scabies was never confirmed.

During the initial visit, LPA observed and interviewed the three (3) residents at the facility who had varying skin conditions or rashes. LPA observed the resident’s rooms, checked mattresses, bed covers, and pillows, and observed residents’ skin. The rashes observed by LPA differed from each other and did not resemble R1’s skin condition. LPA did not observe any indications of bed bugs, lice, or other such parasitic insects in residents’ rooms. LPA interviewed staff who stated that at no point did they have symptoms of scabies or skin irritation after caring for residents and that no skin-related outbreaks have occurred at the facility. Online research states that scabies mites can be transmitted by direct skin-to-skin contact with an infected person, however, no staff members or other residents exhibited scabies symptoms or symptoms similar to R1. LPA also reviewed the facility’s infection control policy and interviewed the Licensee and Administrator who were knowledgeable in infectious disease prevention and control. No concerns were noted. The facility has handled recent unrelated outbreaks by following proper procedure and protocol. No evidence of past scabies or skin-related outbreaks were confirmed. Licensee and Administrator stated that a chemical sheet for the facility was pulled for review for possible irritants to R1, and that R1’s responsible parties were informed that alternative soaps, shampoos, detergents, and lotions could be provided for facility staff to use on R1, as there were concerns of irritants in the products. Per Licensee and Administrator, no staff or other residents contracted anything resembling scabies at any point. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation “Licensee does not ensure that infection control practices are maintained” is deemed UNSUBSTANTIATED at this time.

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

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025
LIC9099 (FAS) - (06/04)
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