405800467-6-10-2025-29-AS-KBUY-DJ5PDV-20250630111408

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405800467
Report Date: 06/10/2025
Date Signed: 06/10/2025 05:02:10 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
06/09/2025 and conducted by Evaluator Garrett Haner-Tomasko

COMPLAINT CONTROL NUMBER: 29-AS-20250609084320

FACILITY NAME:	GARDEN CREEK		FACILITY NUMBER:	405800467
ADMINISTRATOR:	LIZA HIX		FACILITY TYPE:	740
ADDRESS:	73 BROAD STREET		TELEPHONE:	(805) 543-2311
CITY:	SAN LUIS OBISPO	STATE: CA	ZIP CODE:	93405
CAPACITY:	72	CENSUS: 59	DATE:	06/10/2025
		UNANNOUNCED	TIME BEGAN:	08:43 AM
MET WITH:	Administrator - Liza Hix		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility staff are not meeting resident’s care needs.

INVESTIGATION FINDINGS:

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On 6/10/2025 at 08:50am Licensing Program Analyst (LPA) Haner-Tomasko conducted a 10-day complaint visit to the facility above. LPA met with Administrator Liza Hix and explained the purpose of the visit.

LPA requested the following records: Resident Roster, Staff Roster, and Resident 1's (R1's) preadmission appraisal, current physician report and care plan.

From 09:34am to 11:54am LPA conducted interviews with staff and R1.

On allegation: Facility staff are not meeting resident’s care needs. It was alleged R1 requires more care than staff thought and staff are unable to provide R1 water or check on R1 overnight and therefore R1 frequently wakes up dehydrated, and was recently sent to the hospital, but later released because of dehydration.

(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025

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-20250609084320

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: GARDEN CREEK	FACILITY NUMBER: 405800467
	VISIT DATE: 06/10/2025

NARRATIVE

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LPA interviews with staff revealed many of the residents are relatively independent and do not require much hands-on assistance. Staff stated R1 requires the most assistance out of all residents currently and resists staff assistance at times. Staff stated, R1's family hired an outside caregiver just after their admission to the facility to assist facility staff due to increased care needs. Staff stated R1 prefers to stay in bed, but it does take 2 care staff to provide some care to R1. When the outside caregiver is not there staff stated they can radio for help from medication technicians or another available care staff and they receive support form the other staff. Staff stated they are able to meet the residents needs, but feel R1's level of care is too high to reside in the facility. Staff interviews revealed R1 uses a pendant to call staff regularly for assists inlcuding to drink fluids. Staff interviews also revealed that facility caregivers (Personal Care Attendants) do not have a way to review each residents care needs. Staff stated care needs are relayed at shift change meetings, but only medication technicians have access to care plans and resident appraisals.

During LPA interview with R1, R1 stated they prefer to stay in bed, the staff provide assistance when needed, including providing R1 fluids. R1 stated they just want to sleep and not get out of bed.

LPA interview with Lisa Hulse, Vice President of Operations, and resident file review revealed the facility contacted R1's primary care physician regarding R1's change in condition on 5/9/2025, the day after admission, and the physician visited R1 on 5/13/2025. Lisa stated R1 received additional assistance upon admission through home health care agency Central Coast Home Health and after R1's first hospitalization was transitioned to palliative care through the same agency.

LPA record review revealed R1 has been to the hospital two times since in care at the facility and neither visit had a discharge diagnosis of dehydration. Record review revealed three appraisals of R1 were completed prior to R1's admission, a reappraisal due to updated care needs for R1 has not been completed as of today's visit.

Based on all interviews conducted and documents obtained, at this time the above allegation was found to be
unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted, no citation was given at this time and report was provided.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025

LIC9099 (FAS) - (06/04)

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