421701844-4-4-2022-29-AS-KBUY-CD7MAJ-20220405092625

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 421701844
Report Date: 04/04/2022
Date Signed: 04/04/2022 12:45:18 PM

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
11/05/2021 and conducted by Evaluator Toan Luong

COMPLAINT CONTROL NUMBER: 29-AS-20211105095252

FACILITY NAME:	CLIFF VIEW TERRACE		FACILITY NUMBER:	421701844
ADMINISTRATOR:	MURPHY, EVELINA L.		FACILITY TYPE:	740
ADDRESS:	1020 CLIFF DRIVE		TELEPHONE:	(805) 963-7556
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93109
CAPACITY:	72	CENSUS: 27	DATE:	04/04/2022
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Ruby Rodriguez		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility did not have sufficient staffing
Staff are not properly qualified to assist with medications

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Toan Luong conducted an unannounced complaint visit to deliver findings to the facility. LPA met with Assistant Administrator (AA) Ruby Rodriguez and explained the purpose of the visit.

Allegation #1: Facility did not have sufficient staffing
LPA conducted interviews with staff and residents on 11/08/2021. Interviews reveals that there are at least 6 daytime caregivers in the morning and afternoon shift with 3 in the overnight shift. Interviews among residents reveals residents are capable of communicating if needs are not being met. The faciltiy provides meals, medication, and answers call button timely. Residents also stated that the facility is meeting the residents' needs and services. Although the allegation may be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur based on interviews conducted, therefore the allegation is unsubstantiated.
(Continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Toan Luong	TELEPHONE: (626) 419-1827
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2022

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-20211105095252

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: CLIFF VIEW TERRACE	FACILITY NUMBER: 421701844
	VISIT DATE: 04/04/2022

NARRATIVE

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Allegation #2: Staff are not properly qualified to assist with medications
It was alleged that Mission Terrace and Cliff View Terrace did not have licensed certified nursing assistant (CNA) to assist with self-administration of medication to residents. Although Cliff View Terrace is not required to a CNA to assist with medication, LPA reviewed training logs on 11/08/2021 and determined all caregivers received 40 hours of training including 16 hours of hands-on training in January 2020. Records reveal that staff meet the requirements to assist residents with self-administration of medication. Although the allegation may be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur based on record review conducted, therefore the allegation is unsubstantiated.

Exit interview conducted and report emailed.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Toan Luong	TELEPHONE: (626) 419-1827
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2022

LIC9099 (FAS) - (06/04)

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