567610007-8-29-2024-29-AS-DPEA-D8MSZL-20240830141919

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567610007
Report Date: 08/29/2024
Date Signed: 08/29/2024 03:12:29 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
07/24/2024 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20240724111333

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: 106	DATE:	08/29/2024
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Margie Veis		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff is mishandling the residents incontinence needs while in care

Staff are not meeting the residents dental needs

Staff are not meeting the residents hygiene needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent visit to continue investigation for the allegations listed above. Upon arrival LPA met with Nancy Nelson and explained the reason for the visit.
On 07/26/2024, from 10:00 a.m. – 02:45 p.m., LPA initiated an unannounced complaint investigation for the allegations listed above. During the visit, LPA toured the physical plant, interviewed staff as well as reviewed and obtained pertinent documents relevant to the investigation. Today LPA conducted physical plant and interviewed staff.
It was reported that "Staff is mishandling the residents incontinence needs while in care", as it was alleged that there is insufficient supply of incontinent products. Interviews conducted with eleven (11) staff revealed that all (11) have always seen a sufficient supply of incontinence products available. During a physical plant, the LPA found a proper supply of these products in six randomly selected resident rooms in memory care, as well as in a supply closet next to the medication room, the memory care director's office, and a supply closet on the 2nd floor.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

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-20240724111333

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: 08/29/2024

NARRATIVE

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LPA's interview with five (5) families / responsible parties of residents in care revealed that all (5) did not express any potential or immediate concerns that the facility are not meeting the incontinence needs of residents in care. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation, “Staff is mishandling the residents incontinence needs while in care” is deemed Unsubstantiated at this time.

It was reported that "staff are not meeting the residents dental needs" as it was alleged that staff are not ensuring residents are brushing their teeth. Interviews conducted with eleven (11) staff revealed that most residents need some type of assistance with brushing their teeth by either reminding them or fully assisting them with brushing. Interviews with staff further revealed that all (11) have not observed a resident who didn't brush their teeth for a prolonged period of time. Each staff interviewed also did not express any potential or immediate concerns for any staff not assisting resident with brushing their teeth. LPA's interview with five (5) families / responsible parties of residents in care revealed that all (5) did not express any potential or immediate concerns that the facility staff are not meeting resident dental needs. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation, “Staff are not meeting the residents dental needs” is deemed Unsubstantiated at this time.

It was reported that "Staff are not meeting the residents hygiene needs", as it is alleged that residents are not showered in a timely manner. Interviews conducted with eleven (11) staff revealed that most residents usually receive showers 2 to 3 times a week and require some type of assistance according to their care plans. Assistance could involve either reminders or encourage, standby assist, hands on and full assist. All (11) staff also stated they have never seen a resident miss a shower or be delayed in getting one. LPA's interview with five (5) families / responsible parties of residents in care revealed that all (5) did not express any potential or immediate concerns that facility staff are not meeting resident hygiene needs. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation, “Staff are not meeting the residents hygiene needs” is deemed Unsubstantiated at this time.

Exit interview conducted and copy of report issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

LIC9099 (FAS) - (06/04)

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