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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 567609954
Report Date: 08/09/2024
Date Signed: 08/09/2024 05:11:03 PM

Substantiated


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
11/13/2023 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20231113165608
FACILITY NAME:ARTESIAN OF OJAI, THEFACILITY NUMBER:
567609954
ADMINISTRATOR:AMBER L WINTERSTEINFACILITY TYPE:
740
ADDRESS:203 E EL ROBLAR DRIVETELEPHONE:
(805) 798-9305
CITY:OJAISTATE: CAZIP CODE:
93023
CAPACITY:72CENSUS: 38DATE:
08/09/2024
UNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Amber Winterstein TIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Licensee fails to make reasonable efforts to safeguard residents property
INVESTIGATION FINDINGS:
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At 12:10 p.m. Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced subsequent complaint visit at the facility today. The LPA met with Administrator Amber Winterstein and explained the reason for the visit.

On 11/20/2023, at 1:58 p.m., LPAs Emily Peraldi and Elsie Campos conducted an interview with the Administrator. At 2:06 p.m., the LPAs obtained copies of pertinent documents. At 2:55 p.m., the LPAs along with the Administrator conducted a physical plant tour. During today's visit, LPA Cortez conducted a file review, interviewed the Administrator and three (3) staff.

On the allegation that Licensee fails to make reasonable efforts to safeguard residents’ property; it is the concern of the reporting party that several items, including a purple vase with an estimated value of $250-$300, Bath, kitchen and hand towels, large emery board, box of gloves, and a container of wipes went missing from Resident’s #1 (R1’s) room. Report will continue on LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024
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-20231113165608
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: ARTESIAN OF OJAI, THE
FACILITY NUMBER: 567609954
VISIT DATE: 08/09/2024
NARRATIVE
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It was further alleged that there is no designated "lost and found" in the facility and no concern when items go missing from the staff, there is no procedure to find lost items, or to return items received by other than the owner. When notified of a missing item, there is no urgency to follow up on the request from family members to find the item. To investigate the allegation, LPA Cortez conducted a file review and interviews. File review revealed that R1 was admitted to the facility on 05/01/2021 and that R1's file did not have an LIC621 Client/Resident Personal Property and Valuables documentation. R1’s Admissions agreement states that the facility will make reasonable effort to safeguard the resident’s property/valuables, which the Resident/Representative chooses to keep in Resident’s possession but cannot guarantee that items will not be lost or taken. The LPA also reviewed the communities Personal Property/Theft and Loss Policy which states that the community documents and appropriately investigates all alleged and actual theft and loss of personal property, residents are encouraged to notify staff immediately if they notice a personal item is missing, and staff will conduct a thorough investigation and conduct a search for the missing item(s). If the personal belongings cannot be found within 72 hours, an estimate of their value will be assessed. The estimate will be the original purchase price plus or minus any appreciation or depreciation that has occurred. If the theft exceeds $25 or more, it will be documented and upon request readily available, and if the theft exceeds $100 or more a report to the local enforcement agency will be made within 36 hours.

File review and Interview with the Administrator revealed that R1’s authorized person reported missing items on 10/14/2023, which included a purple blown glass vase, towels, whole boxes of gloves and whole containers of wipes. Administrator interview revealed that they personally looked for the items after receiving notification of the missing items, however does not recall the exact dates. After not being able to locate the items they sent out an email, to the management team on 10/24/2023, ten (10) days after the items were reported missing and asked them if anyone had seen a purple vase that belongs to R1. The administrator also stated that they did not document during the investigation of the missing items and did not conduct an estimate of the value of the missing items, as per the communities Personal Property/Theft and Loss Policy. In addition administrator interview revealed that a they informed R1’s authorized person that they did not locate the purple vase on 10/27/2024, however they did not attempt to find a resolution with R1’s authorized person. Furthermore, three (3) out of three (3) staff interviews revealed that they did not look for a purple vase during the time it was reported missing, different reasons were provided. Based on the information gathered during the course of this investigation the allegation is deemed Substantiated at this time.
Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D).Exit interview conducted. Today's reports and appeal rights were reviewed and issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20231113165608
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: ARTESIAN OF OJAI, THE
FACILITY NUMBER: 567609954
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/23/2024
Section Cited
HSC
1569.153(C)(D)
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Theft and loss. (c) Documentation of lost property with a value of twenty-five dollars or more within 72 hours of the discovery of the loss or theft, (d) A written inventory is established … items brought into or ... shall be added... This requirement is not met as evidenced by:
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POC: The Administrator has agreed to the following:
1. Have an in-service training with all staff, including the administrator regarding the facility’s theft and loss policy. Submit training documentation to CCL by POC date.
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Based on interview, and file review the licensee failed to make reasonable efforts to safeguard a resident’s property, as the facility did not follow Theft and Loss Policy, which posed a potential personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024
LIC9099 (FAS) - (06/04)
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