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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 03:28:04 PM

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
07/26/2021 and conducted by Evaluator Kristin Kontilis
COMPLAINT CONTROL NUMBER: 29-AS-20210726135429
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: 66DATE:
05/24/2022
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Karolyn Sorenson, AdministratorTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Facility staff are not providing resident with prescribed diet.
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 and 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.
The reporting party stated the facility would not provide a special diet unless the diet was prescribed by a doctor. Resident 1 (R1) had Type 2 Diabetes and wanted a low glucose diet but did not have a special diet prescribed by their doctor. On 8/2/2021, Dietary Director stated the menu provides multiple items available for each meal for residents who want to substitute items or follow a special diet. Dietary Director provided examples of substitutions for meals, including low sugar and no-sugar options. Dietary Director stated options for breakfast with lower sugar include cottage cheese, fruit, egg, one slice of toast. Dietary Director stated for lunch or dinner, fish could be poached or baked instead of fried, residents could eliminate the bread on a
Unsubstantiated
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-20210726135429
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
VISIT DATE: 05/24/2022
NARRATIVE
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on a sandwich, or they may choose soup or salad. The Dietary Director stated they are not a dietician and cannot create special diets for residents but can provide options to help meet their needs or preferences. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted, copy of report issued via email.

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
LIC9099 (FAS) - (06/04)
Page: 2 of 2