421703341-10-28-2020-29-AS-KBUY-BWTSB7-20201231124327

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 421703341
Report Date: 10/28/2020
Date Signed: 10/28/2020 04:05:30 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE. SUITE 200
GOLETA, CA 93117

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/17/2020 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20200617103012

FACILITY NAME:	PITA BOARD AND CARE		FACILITY NUMBER:	421703341
ADMINISTRATOR:	CHRISTINA PITA		FACILITY TYPE:	740
ADDRESS:	259 MOONCREST		TELEPHONE:	(805) 934-2649
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93455
CAPACITY:	6	CENSUS: 4	DATE:	10/28/2020
		UNANNOUNCED	TIME BEGAN:	02:54 PM
MET WITH:	Gloria Pita, Licensee and Christine Pita, Administrator		TIME COMPLETED:	03:08 PM

ALLEGATION(S):

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Staff speaks inappropriately to residents

INVESTIGATION FINDINGS:

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At 2:54 pm, Licensing Program Analyst (LPA) Chavez initiated a meeting to discuss the final findings for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Gloria Pita, the facility Licensee and Christine Pita, the facility administrator. LPA Chavez explained the purpose of today’s visit.

On the allegation “Staff speaks inappropriate to the residents”, the complainant’s concern was that residents are not being treated with respect by staff. To investigate the allegation, Licensing Program Analyst (LPA) Chavez interviewed the complainant, licensee, administrator, staff, residents, and other credible witnesses; and reviewed facility records.

Continued on 9099-C.

Substantiated

Estimated Days of Completion: 16

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) -59-343
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: 805-450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2020

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-20200617103012

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE. SUITE 200
GOLETA, CA 93117

FACILITY NAME: PITA BOARD AND CARE	FACILITY NUMBER: 421703341
	VISIT DATE: 10/28/2020

NARRATIVE

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Interviews with residents revealed Staff #1 (S1) belittles Resident #1 (R1) and R1 is not treated well. According to interviews, S1 asks residents to go to bed at 6:30 pm and turn off the TV, and that S1 puts Philippine channels on the TV and residents don’t understand what’s being said. According to resident interviews, the administrator has spoken to R1 in a “snappy” tone. Resident interviews revealed an incident, which occurred a few years ago when a former Resident #3 (R3) and S1 “Got into it, screaming many times” and R3 “had tears in her eyes.” Residents described interactions with staff as “unnecessary aggression, heckling, and they [staff] don’t allow us to talk, they don’t like us socializing with each other, they say ‘Don’t talk, just eat, don’t complain.’” Residents interviewed also stated staff is “sometimes” rude or demeaning and feel that staff think the residents are “stupid” based on the staffs’ words and actions. Residents also stated staff scold the residents. Interviews with a credible witness reveals S1 is “loud, pushy, and direct” and has been observed to act this way on several different occasions.

On 6/25/2020 at 4:07 pm, Administrator Christine Pita stated she has heard S1 speak loudly to the residents and that it comes across as rude, and the administrator has asked S1 to “talk softly.” On 6:25/2020 at 4:14 pm, LPA interviewed S1 who stated S1 does not see anything wrong with how S1 treats the residents, particularly R1. S1 stated S1 is nice to R1. S1 stated S1 accepts whatever R1 does, and just does the job.

Based on the information obtained, the allegation that, “Staff speaks inappropriate to the residents”, is Substantiated.

At 3:08 pm, a telephonic exit interview was conducted with Gloria Pita and Christine Pita, and an electronic copy of the report was emailed for signature to be returned to LPA Chavez by email.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) -59-343
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: 805-450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20200617103012

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE. SUITE 200
GOLETA, CA 93117

FACILITY NAME: PITA BOARD AND CARE	FACILITY NUMBER: 421703341
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/28/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/13/2020 Section Cited HSC 1569.269(a)(1)	1 2 3 4 5 6 7	1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidneced by:	1 2 3 4 5 6 7	Administrator has agreed to have personal rights training conducted with all staff. Administrator has agreed to have staff trained by Ombudsman on personal rights and caregiving. Training will be completed by November 13, 2020.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply with the regulation above, the licensee did not ensure staff were treating residents in care with dignity at all times.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) -59-343
LICENSING EVALUATOR NAME: Darlene Chavez	TELEPHONE: 805-450-0283
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2020

LIC9099 (FAS) - (06/04)

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