567609978-5-19-2025-29-AS-KBUY-DJ62YC-20250630174830

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609978
Report Date: 05/19/2025
Date Signed: 05/19/2025 03:46:00 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
06/12/2024 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20240612102044

FACILITY NAME:	CYPRESS PLACE ASSISTED LIVING		FACILITY NUMBER:	567609978
ADMINISTRATOR:	GINA SALMAN		FACILITY TYPE:	740
ADDRESS:	1200 CYPRESS POINT LANE		TELEPHONE:	(805) 650-8000
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	89	CENSUS: 71	DATE:	05/19/2025
		UNANNOUNCED	TIME BEGAN:	10:56 AM
MET WITH:	Gina Rozaner		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not ensure resident's room was kept in clean, sanitary conditions.
Staff did not provide resident with a comfortable environment.
Staff did not safeguard resident’s personal belongings.
Staff are not providing adequate laundry service.
Staff over medicated resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit regarding the above noted allegations. LPA met with administrator/executive director (ED) Gina Rozaner and explained the reason for the visit.

On 6/19/2024, LPA Camara conducted an initial complaint investigation visit. During that visit LPA toured the facility and reviewed pertinent documents. On 11/26/2024, LPA Esther Cortez conducted a visit in which she toured the facility, including five (5) residents’ rooms. On 12/4/2024, LPA Camara conducted a tour of the facility and interviewed two staff during the visit. On 4/11/2025, LPA Camara conducted interviews with five (5) staff and two (2) residents. LPA attempted interviews with two (2) residents in memory care, inspected their rooms, and toured the memory care unit. On 5/8/2025, LPA interviewed two witnesses who frequently visit but are not employed by the facility and toured the facility, including the kitchen and ten (10) residents’ rooms. During today’s visit, LPA interviewed six (6) residents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025

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-20240612102044

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: CYPRESS PLACE ASSISTED LIVING	FACILITY NUMBER: 567609978
	VISIT DATE: 05/19/2025

NARRATIVE

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Regarding the allegations: Staff did not ensure resident’s room was kept in clean, sanitary conditions, Staff did not provide resident with a comfortable environment, and Staff are not providing adequate laundry service.
LPA interviewed staff, witnesses not employed by the facility, and eight (8) residents. None have witnessed the facility unkempt. The residents indicated they are on a schedule for cleaning days one time per week but if there is a mess that needs to be cleaned, they can contact staff, and they will clean the room. Memory care rooms are checked daily by staff and if a room requires attention, they will contact housekeeping, or the caregiver will clean it themselves. Residents stated they are comfortable at the facility and did not have any complaints about the cleanliness or temperature of the facility. All the residents stated they are on a schedule for laundry service, and they had no complaints about how the facility does their laundry. One resident stated they are allergic to the detergent the facility uses so the facility accommodates this resident by using a different detergent purchased by the resident. Based on interviews and observations, this allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff did not safeguard resident’s personal belongings.
LPA interviewed eight residents who stated they have not had anything taken from them. A couple residents stated they thought things were missing but staff helped them find the items in their rooms. A couple residents stated they had some items like socks missing but staff helped them find their items. The witnesses who were interviewed stated they had not heard about anything coming up missing from residents’ rooms. Based on interviews, this allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff over medicated resident while in care.
This allegation was specifically regarding resident 1 (R1) being over medicated due to behaviors. LPA interviewed staff who stated R1 does not have behavioral issues. R1 is quite pleasant and enjoys going to activities. R1 does take a medication which can cause drowsiness but there have not been any noted concerns about R1 seeming overly drowsy. R1 has been on this medication at the same dose since 2022. Medications are given as prescribed by the physician. Based on interviews, observation of R1, and record review, this allegation is deemed Unsubstantiated at this time.

No deficiencies observed. Exit interview conducted and report issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025

LIC9099 (FAS) - (06/04)

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