Complaint Investigation Report

(PAGE 2) Report continued from LIC 9099...

On 08/14/2025 LPA Mosley conducted an unannounced subsequent complaint visit. Starting at 10:40 a.m. LPA and staff conducted a physical plant tour to ensure there are no immediate health and safety concerns, starting at 12:30 p.m. LPA conducted three (3) in-person interviews, one (1) resident and two (2) staff including the Licensee Representative /Administrator, conducted a file review and obtained copies of pertinent documents relevant to the investigation. On 08/26/2025 at 3:04 p.m. conducted a telephonic interview with a Power of Attorney of Resident #1 (POA R1). On 08/27/2025 at 3:37 p.m. attempted to conduct a telephonic interview with Resident #1 (R1). On 08/27/2025 at 4:04 p.m. attempted to conduct a telephonic interview with a Power of Attorney of Resident #2 (POA R2). On 09/03/2025 at 10:00 a.m. LPA conducted a collateral visit to a Skilled Nursing Facility (SNF) and interviewed R1 at 11:06 a.m.

On 09/03/2025, the LPA conducted a subsequent visit at the facility. Starting at 1:25 p.m. LPA and staff conducted a brief physical plant tour to ensure there are no immediate health and safety concerns starting at 1:34 p.m. LPA conducted one (1) in-person resident interview and attempted to obtain copies of pertinent documents relevant to the investigation. On 09/03/2025 at 4:31 p.m. attempted to conduct a telephonic interview with Individual #1 (I1). On 09/03/2025 requested police report related to the incident from Ventura County Sherrif’s Department. On 09/04/2025 Received Police report from Ventura County Sherrif’s Department. On 09/04/2025 Subpoenaed hospital records for R1. On 9/04/2025 at 8:31 p.m. and 9:16 p.m. conducted a telephonic interview with Ventura County Sheriff’s Department responding Deputy (VCSD). On 09/04/2025 at 4:36 p.m. conducted a telephonic interview with Individual #2 (I2). On 09/04/2025 at 3:41 conducted a telephonic interview with I1. On 09/09/2025 received the incident report for R1 for an incident that occurred on 07/31/2025. The facility was cited on a different visit regarding reporting requirements. On 09/24/2025 at 1:28 p.m.,09/25/2025 at 8:45 a.m. and on 09/26/2025 at 3:37 p.m. the LPA attempted to conduct a telephonic interview with the POA for R2. On 09/26/2025 at 4:08 p.m. LPA attempted to conduct a telephonic interview with Responsible Person of former resident, Resident #3 (RPR3). On 09/29/2025 at 10:08 a.m and 4:38 p.m. LPA attempted to conduct a telephonic interview with RPR3. On 09/30/2025 received hospital records for R1. On 10/01/2025 at 11:46 a.m. and 4:42 p.m. and on 10/06/2025 at 10:22 a.m. LPA attempted to conduct a telephonic interview with RPR3. On 10/06/2025, LPA reviewed hospital records for R1.