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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425800837
Report Date: 05/24/2022
Date Signed: 05/24/2022 03:20:00 PM

Substantiated


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
07/23/2021 and conducted by Evaluator Kristin Kontilis
COMPLAINT CONTROL NUMBER: 29-AS-20210723125716
FACILITY NAME:GARDEN COURT AT VILLA SANTA BARBARAFACILITY NUMBER:
425800837
ADMINISTRATOR:STEFANIA RADUFACILITY TYPE:
740
ADDRESS:227 E. ANAPAMU STREETTELEPHONE:
(805) 963-4428
CITY:SANTA BARBARASTATE: CAZIP CODE:
93101
CAPACITY:126CENSUS: 16DATE:
05/24/2022
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Karolyn Sorenson, AdministratorTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Facility has bugs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kristin Kontilis conducted a subsequent complaint visit to issue final findings on the above-stated allegation. LPA met with Karolyn Sorenson, Administrator and Rick Olds, Administrator. LPA explained the purpose of the visit. During the investigation, LPA Kontilis toured the facility on 8/2/2021 at 12:30 pm, and conducted interviews of staff and residents between 12:45 pm and 3:15 pm. LPA also reviewed photographic evidence provided.
The reporting party stated they had observed bugs in the facility for approximately 4 months. LPA reviewed photographs that showed flies on plates and cups in the dining room of the facility. On 8/2/2021 at 12:45pm, Dietary Director admitted to observing 1 to 2 flies in the dining room when the weather was hot, approximately two weeks prior. On the 8/2/2021 visit, LPA observed a screen in dining room torn, and issued a citation on a case management visit. Based on the information obtained, the allegation is deemed Substantiated at this time.
Exit interview, report emailed, deficiencies cited on 9099-D, appeal rights emailed.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 29-AS-20210723125716
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: GARDEN COURT AT VILLA SANTA BARBARA
FACILITY NUMBER: 425800837
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2022
Section Cited
CCR
87303(a)
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87303(a) Maintenance and Operation. (a) The facility shall be clean, safe, sanitary and in good repair at all times.

This requirement was not met as evidenced by:
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Facility arranged for extermination services on 8/3/2021 and 8/17/2021. POC cleared during visit.
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Based on interviews and record review, the licensee did not comply with the section cited above as they failed to ensure the facility was free of insects, which poses a potential health risk to residents in care.
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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: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2