425800464-3-4-2025-29-AS-KBUY-DF7KY7-20250328081840

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425800464
Report Date: 03/04/2025
Date Signed: 03/04/2025 02:55:25 PM

Substantiated

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
02/25/2025 and conducted by Evaluator Garrett Haner-Tomasko

COMPLAINT CONTROL NUMBER: 29-AS-20250225143815

FACILITY NAME:	VISTA DEL MONTE		FACILITY NUMBER:	425800464
ADMINISTRATOR:	DOUGLAS TUCKER		FACILITY TYPE:	741
ADDRESS:	3775 MODOC ROAD		TELEPHONE:	(805) 687-0793
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93105
CAPACITY:	266	CENSUS: 207	DATE:	03/04/2025
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Administrator - Douglas Tucker		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff did not meet the resident's needs.

INVESTIGATION FINDINGS:

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On 03/04/2025, Licensing Program Analyst (LPA) Garrett Haner-Tomasko and Licensing Program Manager (LPM) Kelly Burley conducted an initial complaint visit to investigate the above allegation. LPA met with Administrator Douglas Tucker and explained the purpose of the visit.

During the visit from 10:15am to 3:00pm, LPA and LPM interviewed administrator, staff, private caregivers, residents, visitors, and obtained relevant documents.

On the allegation: Facility staff did not meet resident's needs. The investigation revealed on one occasion over a holiday weekend, Resident 1 (R1) was found on the floor, still in their pajamas around 9:30am, had not had breakfast, and was soiled. Interviews revealed on 2/17/2025, a registry staff was on shift and was not aware of R1’s typical schedule to get up around 6:30am-7am, earlier than some residents. Most residents wear pendants that detect falls and alert staff.
(Continued 9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025

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-20250225143815

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: VISTA DEL MONTE	FACILITY NUMBER: 425800464
	VISIT DATE: 03/04/2025

NARRATIVE

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However, R1 slid out of bed so there was no fall detected and no alert. This was the first time R1 slid out of bed, however it has happened twice more following this incident. R1’s private caregiver provided care to R1, and R1’s family and physician were notified. Per the care plan R1 is to be checked on during the night three times by staff. Care Services Manager (CSM) reminded all staff during shift change of R1’s specific and different routine, to ensure R1’s needs were met in the future. CSM stated service plans that are printed in the break room would be on updated to include preferred times of care, rather than just the care needed. CSM stated a care meeting was held 3/4/2025 with facility staff and R1’s health advocate. CSM discussed fall mitigation options such as a hospital bed, floor mat, hip pads, and using a Purewick system. Interviews indicated this was the only time R1 was found like this. Other residents interviewed indicated their needs were met. Based on the information obtained, the allegation is deemed Substantiated at this time.

Exit interview, technical violated issued, copy of report given, appeal rights given.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Garrett Haner-Tomasko
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025

LIC9099 (FAS) - (06/04)

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