421703748-5-21-2026-29-AS-KBUY-DUJN9Q-20260529101616

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 421703748
Report Date: 05/21/2026
Date Signed: 05/21/2026 09:25:04 AM

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
05/06/2026 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20260506124722

FACILITY NAME:	PURISIMA HILLS		FACILITY NUMBER:	421703748
ADMINISTRATOR:	SUSAN MARSH		FACILITY TYPE:	740
ADDRESS:	237 ALDEBARAN AVENUE		TELEPHONE:	(805) 733-4395
CITY:	LOMPOC	STATE: CA	ZIP CODE:	93436
CAPACITY:	6	CENSUS:	DATE:	05/21/2026
		UNANNOUNCED	TIME BEGAN:	05:10 AM
MET WITH:			TIME COMPLETED:	09:35 AM

ALLEGATION(S):

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Facility is not meeting resident's diabetic needs.

Facility did not follow physician's orders.

INVESTIGATION FINDINGS:

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At 5:10am on 05/21/2026, Licensing Program Analyst (LPA) Jeffries arrived to the facility unannounced to continue the investigation to the allegations to this complaint. LPA met with Care Staff 2 (S2) announce who he is and the reason for the visit. LPA texted the Administrator Susan Marsh and informed her of LPA arrival to the facility.
LPA conducted observations of Residents morning routines, including, waking, clothes preparation, breakfast, and medication administration.LPA also conducted interview with Resident (R1) and Staff (S2). LPA collected enough evidence to determine and delever final findings as flollows:
As to the allegation of, “Facility is not meeting resident’s diabetic needs.” It was alleged that, facility is not following diabetic diet and diabetic care. It was discovered on 05/21/2026 LPA Jeffries conducted a facility continuing investigation visit at 5:10am and observed R1 morning preparation. LPA observed Staff 1 (S1) assisting residents with basic morning routines, including but not limited to dressing, grooming, hygiene, medication administration, breakfast and transportation transfer to day program. CONTINUED on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

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-20260506124722

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: PURISIMA HILLS	FACILITY NUMBER: 421703748
	VISIT DATE: 05/21/2026

NARRATIVE

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On 05/21/2026, LPA conducted an in-person interview with S2. S2 stated that R1’s blood glucose level was read by S2 at 5:00am via auto read monitor from arm sensor. S2 stated that they adjusted the auto injector to the appropriate level, alcohol swabbed R1s injection spot and R1 self administered insulin using self-injection pen. On 05/21/2026, LPA conducted an in-person interview with R1. When R1 was asked if they had taken their insulin this morning, R1 replied “Yes”, when asked if R1 self injects their own insulin, R1 replied “Yes I do.” When asked if R1 has any problems with injecting their own insulin, R1 stated, “No, I don’t.” LPA noted that R1 was able to answer basic questions with no hesitation or confusion. On 05/21/2026, LPA observed residents’ breakfast to be a protein based meal of eggs and beans. On 05/21/2026, LPA reviewed an updated LIC602 (Physicians Report) singed and dated 05/12/2026, stating Ri is able to administer own injections (with assistance and supervision), and able to perform own glucose testing (with assistance and supervision). LPA collected documentation of weekly meal consumption for R1 showing a protein based diet. Based on interviews, documentation and observation there is not enough evidence at this time to support the allegation of, “Facility is not meeting resident’s diabetic needs.” and is unsubstantiated at this time.
As to the allegation of, “Facility did not follow physician’s orders.” It was alleged that Administrator, “took it upon herself” to discontinued Resident 1’s (R1) AM medication. It was discovered on 05/11/2026 by Licensing Program Analyst (LPA) Jeffries, through a medication audit, and medication documentation review and interviews, that on 05/11/2026 a review of R1’s Centrally Stored Medication Record (CSMR) showed that R1’s medication was discontinued on 01/14/2026; a review of R1’s Medication Administration Record (MAR) showed that last time R1 had taken that medication was in the AM of 01/14/2026; on 05/14/2026 LPA received and reviewed NEW PRESCRIPTION SUMMARY from Life Tree Pharmacy, dated 01/15/2026, showing “d/c (medication A). Start (medication B) 01/15/2026” per Physician’s prescription. On 05/11/2026, LPA Jeffries conducted an in-person interview with Administrator, Susan Marsh who stated that R1’s medication was changed by R1’s physician and the prescription was sent to the pharmacy by the physician. Administrator denies personally changing R1’s medications without physician consultation, prescription and discontinuance of any of R1’s medications. At this time there is not sufficient evidence to support the allegation of, “Facility did not follow physician’s orders.” and is unsubstantiated at this time.

Exit interview, report read and report provided.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

LIC9099 (FAS) - (06/04)

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