567610007-12-4-2023-29-AS-DPEA-CYN2VM-20231218164410

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567610007
Report Date: 12/04/2023
Date Signed: 12/04/2023 10:21:01 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/30/2023 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20230530092434

FACILITY NAME:	VARENITA OF SIMI VALLEY		FACILITY NUMBER:	567610007
ADMINISTRATOR:	VEIS, MARGIE		FACILITY TYPE:	740
ADDRESS:	3921 COCHRAN STREET		TELEPHONE:	(805) 327-1100
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93063
CAPACITY:	110	CENSUS: 96	DATE:	12/04/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Margie Veis		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff is using illegal drugs at the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Martha Arroyo conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA Arroyo met with Executive Director, Margie Veis and explained the reason for the visit.

On 05/30/2023, the Department received a complaint alleging Staff #1 (S1) was using illegal drugs (suspected to be crystal methamphetamine or cocaine) while on the premises. The complaint was referred to the Community Care Licensing (CCL) Investigations Branch (IB) and assigned to Investigator Dennis Seng.

(Report Continued on LIC 9099C...)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

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-20230530092434

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VARENITA OF SIMI VALLEY	FACILITY NUMBER: 567610007
	VISIT DATE: 12/04/2023

NARRATIVE

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(Report Continued from LIC 9099...)

On 05/30/2023, from 1:30 p.m. to 5:15 p.m., Licensing Program Analyst (LPA), Martha Arroyo conducted an initial complaint visit. During the visit, LPA met with Health Services Director Vivian Reyes. At 1:45 p.m., the LPA conducted a tour of the facility to ensure there were no health and safety hazards. At 3:50 p.m., the LPA conducted a facility file review and obtained copies of pertinent documents relevant to the investigation. Investigator Seng conducted interviews on 06/01/2023, at approximately 12:02 p.m., with the reporting party; on 06/05/2023, from approximately 1:07 p.m. to 4:54 p.m., with various facility staff, residents and S1.
In addition, the investigator reviewed staff schedules, personnel files, and photos.

The investigation revealed on 05/22/2023, at approximately 1:30 a.m., staff reported to the overnight supervisor that S1 had passed out in the bathroom inside a resident's room. S1 needed help with pulling their pants up, S1 was on the bathroom floor. S1 stated they needed help getting up, because S1 had no feelings in their legs or feet. The supervisor went to the resident’s room and found S1 on their knees, "pretending," to clean. S1 appeared to be groggy and under the influence of a drug. The supervisor went to the staff room to check in S1’s purse and found a black container with a white powder inside. The supervisor confiscated the container and turned it in to management for testing. The supervisor was then terminated for an unauthorized search of S1’s purse.

S1 admitted that they were under the influence of marijuana (THC crystals) while providing care for the residents on 05/22/2023 and while on duty. S1 provided photographs of the marijuana they used while working. Per S1’s co-workers, they suspected S1 of being under the influence of an unknown drug due to S1’s behavior, S1 would act jittery, and appear to be incoherent while working. S1 was terminated August 2023 due to poor performance and not completing their job duties.

Based on the information gathered during the course of the investigation, the Department has sufficient evidence to determine that S1 was under the influence of drugs while working. Therefore, the allegation “Staff is using illegal drugs at the facility” is deemed substantiated at this time.

Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 9099-D)

Exit interview conducted, civil penalty issued, appeal rights discussed, and a copy of this report issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230530092434

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VARENITA OF SIMI VALLEY	FACILITY NUMBER: 567610007
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/04/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/04/2023 Section Cited HSC 1558	1 2 3 4 5 6 7	(a) The department may prohibit any person from... continuing the employment of, or allowing in a licensed facility or certified family home, or allowing contact with clients of a licensed facility or certified family home by, any employee, prospective employee, or person who is not a client who has:	1 2 3 4 5 6 7	The Licensee has agreed to the following: 1.) The Licensee terminated S1. 2.) The Licensee will submit a plan on how the facility will ensure this situation does not occur again and submit to CCL by 12/15/2023. Civil Penalty issued.
	8 9 10 11 12 13 14	(2) Engaged in conduct that is inimical to the health, morals, welfare, or safety of either the people of this state or an individual in, or receiving services from, the facility or certified family home. This requirement is not met as evidenced by:	8 9 10 11 12 13 14	Based on S1’s admission and photos of the crystal marijuana submitted by S1, S1 was under the influence of drugs while working at the facility, which posed an immediate health and safety risk to residents in care.
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	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

LIC9099 (FAS) - (06/04)

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