567609978-5-19-2025-29-AS-KBUY-DJ632C-20250630175143

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609978
Report Date: 05/19/2025
Date Signed: 05/19/2025 03:44:23 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
11/22/2024 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20241122140616

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:	10:57 AM
MET WITH:	Gina Rozaner		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff does not ensure residents rooms are kept free of mal odors
Staff does not ensure floors in residents room are kept clean
Staff does not ensure residents are spoken to in an appropriate manner
Staff has inappropriate conversations with other staff while in the presence of residents.
Staff does not ensure facility is kept free of rodents
Staff do not ensure proper assessments are done during pre-admission of residents

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 11/26/2024, LPA Esther Cortez conducted an initial complaint investigation visit. During her visit she interviewed the ED and conducted a tour of the facility, including five (5) residents’ rooms. On 12/4/2024, LPA Camara conducted a tour of the facility, including the independent living facility adjacent to this facility. LPA Camara 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-20241122140616

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 does not ensure residents’ rooms are kept free of mal odors, Staff does not ensure floors in residents’ rooms are kept clean, and Staff does not ensure facility is free of rodents.
LPA interviewed seven (7) staff, eight (8) residents, and two witnesses not employed by this facility. In addition, LPA conducted a full facility inspection, toured the independent living building, and inspected a total of fifteen (15) residents’ rooms. Rooms were free of mal odors, clean, and there was no evidence of rodents found anywhere in the facility, including the kitchen and food storage areas. None of those interviewed noted any concerns regarding cleanliness or odors and none had ever seen evidence of rodents at the facility. Based on interviews and observations, these allegations are deemed Unsubstantiated at this time.

Regarding the allegations: Staff does not ensure residents are spoken to in an appropriate manner and Staff has inappropriate conversations with other staff while in the presence of residents.
LPA interviewed seven (7) staff, eight (8) residents, and two witnesses not employed by this facility. None of the residents had ever been subjected to staff speaking in an inappropriate manner to them or around them. None of the staff or others interviewed had ever witnessed any staff speak in an inappropriate manner to or around residents. Based on these interviews, these allegations are deemed Unsubstantiated at this time.

Regarding the allegation: Staff do not ensure proper assessments are done during pre-admission of residents.
This allegation was specifically regarding residents of the independent living apartment building adjacent to this licensed assisted living facility. Community Care Licensing does not license the independent living apartment building; however, the ED took the LPA on a tour of the independent living building and LPA spoke with their marketing director who manages that building. The ED and marketing director both confirmed they do not provide care and supervision at the independent living building. Some residents hire private companions and/or receive home health services if they are recovering from something but there are no staff who provide care. They also stated if any of the staff who work at the independent living building notice a tenant showing signs of increased confusion, forgetfulness, or physical inabilities, the staff will report it to the marketing director and they will speak with the tenant and their family about the need for care and supervision. The ED stated, during her time at this facility, there have been approximately ten (10) tenants who became residents of the assisted living facility once they needed care and supervision. Based on this information, 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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