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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 567610007
Report Date: 01/18/2024
Date Signed: 01/18/2024 03:20:52 PM

Unsubstantiated


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
05/22/2023 and conducted by Evaluator Martha Arroyo
COMPLAINT CONTROL NUMBER: 29-AS-20230522161041
FACILITY NAME:VARENITA OF SIMI VALLEYFACILITY NUMBER:
567610007
ADMINISTRATOR:VEIS, MARGIEFACILITY TYPE:
740
ADDRESS:3921 COCHRAN STREETTELEPHONE:
(805) 327-1100
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:110CENSUS: 100DATE:
01/18/2024
UNANNOUNCEDTIME BEGAN:
01:58 PM
MET WITH:Margie VeisTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
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5
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7
8
9
Staff speak to residents in an inappropriate manner.
Staff does not provide a safe environment for residents.
Staff are not properly trained to administer residents’ medications.
Staff caused a resident to bleed.
Staff eats resident's food.
Staff inappropriately cleaned the dining room tables at the facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPA’s), Martha Arroyo and Brian conducted a subsequent visit to the facility to issue findings for the above allegations. The initial visit was conducted on 05/30/2023 and a subsequent visit was conducted on 06/08/2023 by LPA M. Arroyo. During today's visit, LPAs met with Executive Director, Margie Veis, and the reason for the visit was explained. Entrance interview.

During the initial visit on 05/30/2023, at 1:45 p.m., LPA Arroyo conducted a tour of the facility to ensure there are no health and safety hazards, conducted interviews with seven staff, four residents, and one family member between 2:07 p.m. and 4:45 p.m., and conducted a file review at 3:50 p.m. and obtained copies of pertinent documents. On 06/08/2023, LPA Arroyo conducted interviews with the Executive Director and three staff between 9:32 a.m. and 10:00 a.m. and conducted a file review at 10:30 a.m. and obtained copies of pertinent documents. On 10/03/2023, LPA Arroyo conducted telephonic interviews with three family members at 10:25 a.m., 10:40 a.m., and 11:20 a.m.
(Report Continued on LIC 9099C...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
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 5
Control Number 29-AS-20230522161041
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: 01/18/2024
NARRATIVE
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14
15
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32
(Report Continued from LIC 9099...)

It was alleged that staff speak to residents in an inappropriate manner and staff does not provide a safe environment for residents. It was reported that Staff #1 (S1) commands and disrespects the residents when talking and interacting and has at times used profanity words causing the resident to be in an unsafe environment. Interviews conducted with staff revealed that facility staff have not observed S1 speak inappropriately to residents in care. Additionally, staff denied observing or hearing any other facility staff mistreating residents. Interviews conducted with family members revealed that they have observed facility staff interact with residents while visiting, and all interactions have been of staff being gentle and respectful when assisting the residents. Also, family members stated they have seen how the staff interact with the residents and the staff were professional and caring. Furthermore, family members stated having no concerns and feel the residents are safe while living at the facility. Based on interviews conducted with staff and family members, the Department does not have sufficient evidence to support the allegations of “staff speak to residents in an inappropriate manner” and “staff does not provide a safe environment for residents”. Therefore, these allegations are deemed Unsubstantiated at this time.

It was also alleged that staff are not properly trained to administer residents’ medications. It was reported that S1 has not completed the necessary training to be a medication technician and administer medication to residents. Interviews conducted with staff revealed that training is given to all staff upon hiring. Additionally, staff stated they are required to complete the online training assigned as well as the week of shadowing different staff members prior to being able to start providing care to residents. Records review revealed that facility now utilizes Care Academy as it transitioned to the new management; however, the facility was using the services provided from Relias. Nevertheless, the facility maintains copies of all completed training from their staff. Additionally, review of S1’s training folder revealed that S1 has completed sixty-five out of the sixty-seven training's listed under S1’s Care Staff Initial Training Curriculum. Furthermore, the training that has been completed include all the necessary training on assisting with the administration of medication and the hours from shadowing another care staff. Based on records review and interviews conducted, the Department does not have sufficient evidence to support the allegation of “staff are not properly trained to administer residents’ medications”. Therefore, this allegation is deemed Unsubstantiated at this time.

(Report Continued on LIC 9099C...)

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20230522161041
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: 01/18/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Report Continued from LIC 9099...)

It was also alleged that staff caused a resident to bleed. It was reported that Staff #2 (S2) had popped a pimple on a resident while they slept. Interviews conducted with staff revealed that they strive to meet the residents’ basic needs. Additionally, staff stated they had no knowledge of the incident mentioned and denied seeing or hearing of other staff mistreating the residents. Interviews conducted with family members revealed that while visiting the facility, they have observed the staff be gentle and respectful when assisting the residents. Furthermore, family members reported having no concerns with the facility or the staff. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “staff caused a resident to bleed”. Therefore, this allegation is deemed Unsubstantiated at this time.

It was further alleged that staff eats resident’s food and staff inappropriately cleaned the dining room tables at the facility. It was reported that S2 has eaten the resident’s food and has been seen cleaning the dining room tables with the floor broom. Interviews with staff revealed that the maintenance director trains all staff in housekeeping at least once a month. The training is conducted with all staff on properly cleaning and maintaining the work area, which includes handling and storing chemicals as they are providing care inside the memory care unit. Additionally, staff stated that residents’ food does not get touched by the staff unless they are assisting the residents during their mealtimes. In addition, staff denied seeing S2 eating the resident’s food and cleaning the dining room tables inappropriately. Furthermore, interviews conducted with family members revealed they had no concerns about the facility staff. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “staff eats residents’ food” and “staff inappropriately cleaned the dining room tables at the facility”. Therefore, these allegations are deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued at this time. A copy of the report was provided.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
05/22/2023 and conducted by Evaluator Martha Arroyo
COMPLAINT CONTROL NUMBER: 29-AS-20230522161041

FACILITY NAME:VARENITA OF SIMI VALLEYFACILITY NUMBER:
567610007
ADMINISTRATOR:VEIS, MARGIEFACILITY TYPE:
740
ADDRESS:3921 COCHRAN STREETTELEPHONE:
(805) 327-1100
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:110CENSUS: 100DATE:
01/18/2024
UNANNOUNCEDTIME BEGAN:
01:58 PM
MET WITH:Margie VeisTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff is under the influence at work.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent visit to the facility to issue findings for the above allegations. The initial visit was conducted on 05/30/2023 and a subsequent visit was conducted on 06/08/2023 by LPA M. Arroyo. During today's visit, LPA met with Executive Director, Margie Veis, and the reason for the visit was explained. Entrance interview.

During the initial visit on 05/30/2023, at 1:45 p.m., LPA Arroyo conducted a tour of the facility to ensure there are no health and safety hazards, conducted interviews with seven staff, four residents, and one family member between 2:07 p.m. and 4:45 p.m., and conducted a file review at 3:50 p.m. and obtained copies of pertinent documents. On 06/08/2023, LPA Arroyo conducted interviews with the Executive Director and three staff between 9:32 a.m. and 10:00 a.m. and conducted a file review at 10:30 a.m. and obtained copies of pertinent documents. On 10/03/2023, LPA Arroyo conducted telephonic interviews with three family members at 10:25 a.m., 10:40 a.m., and 11:20 a.m.
(Report Continued on LIC 9099...)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20230522161041
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: 01/18/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Report Continued from LIC 9099...)

It was alleged that staff is under the influence at work. It was reported that several staff had observed Staff #2 (S2) display questionable actions and behavior while working at the facility and assisting residents. During the course of the investigation, it was revealed that S2 had admitted to being under the influence of marijuana while working as a care provider on 05/22/2023. Additionally, S2 provided photographs of the marijuana S2 was using while working. Furthermore, S2 was terminated August 2023 due to poor performance and not completing their job duties. Based on all information gathered during the course of the investigation in conjunction with CC# 29-AS-20230530092434 from 05/30/2023, the above allegation, “staff is under the influence at work” is deemed Substantiated at this time.

Although the allegation was Substantiated. The department may prohibit any person from continuing employment if they have 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… has already been cited on a previous visit from 12/04/2023.

Exit interview conducted. Appeal rights and report were reviewed, and a copy was issued.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5