567610007-6-16-2023-29-AS-DPEA-CT7SSW-20230627140836

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567610007
Report Date: 06/16/2023
Date Signed: 06/16/2023 02:57:31 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
05/30/2023 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20230530154616

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: 81	DATE:	06/16/2023
		UNANNOUNCED	TIME BEGAN:	02:25 PM
MET WITH:	Margie Veis		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Licensee is not addressing flea outbreak at the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent visit to the facility to issue findings for the above allegation. The initial visit was conducted on 05/30/2023 and a subsequent visit was conducted on 06/08/2023 by LPA M. Arroyo. On today’s visit, LPA Arroyo met with Executive Director (ED), Margie Veis and the reason for the visit was explained. Entrance interview.

During the initial visit on 05/30/2023, LPA Arroyo conducted a tour of the facility to ensure there are no health and safety hazards at 1:45 p.m., conducted an interview with one staff at 2:07 p.m., and requested the Health Services Director email documentation by 05/31/2023. On 06/08/2023, LPA Arroyo conducted interviews with the ED and three staff between 9:32 a.m. and 10:00 a.m., and conducted a file review and obtained copies of pertinent documents at 10:30 a.m.

Unsubstantiated

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: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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-20230530154616

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: 06/16/2023

NARRATIVE

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Report Continued from LIC 9099...

It was alleged that licensee is not addressing flea outbreak at the facility. Reporting Party (RP) stated that a staff member had walked into the facility with fleas on their clothes and it was reported to management and maintenance. The facility had a pest control company clean and treat the facility; however, RP stated a few staff members had flea bites and reported seeing some residents having fleas on their clothes. Interviews conducted with management revealed a staff member had reported seeing fleas in the memory care unit, to which the facility promptly had a pest control company come out to the facility and inspect as well as treat if needed. Interviews with staff revealed they have not seen any fleas in the facility and reported having no concerns with fleas or pests. Furthermore, records reviewed revealed facility had Ecolab Pest Elimination Division inspect for potential flea activity seen by the night shift in the memory care unit. The pest control company reported no fleas were seen during the inspection, and residual spray was used to treat all hallways and dining areas in memory care and main dining area as well as treated doors to help reduce potential fly and mosquito entry. Based on the information obtained and reviewed during the course of the investigation, the Department does not have sufficient evidence to support the allegation of “licensee is not addressing flea outbreak at the facility”. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was issued issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

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