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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425800837
Report Date: 12/21/2023
Date Signed: 12/21/2023 09:49:21 AM

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
09/17/2021 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20210917135203
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:0CENSUS: 0DATE:
12/21/2023
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:TIME COMPLETED:
09:20 AM
ALLEGATION(S):
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Facility did not meet Resident’s needs by failure to conduct re-appraisal(s).
Staff did not follow physician's orders for resident's meals.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Olson mailed findings to the licensee for this investigation, as the facility closed and underwent a change of ownership effective 3/24/2023. During the investigation, LPA Kontilis toured the facility, reviewed relevant documents, and conducted interviews with staff and responsible parties.

On the allegation: Facility did not meet Resident’s needs by failure to conduct re-appraisal(s). It was alleged that staff was supposed to have Resident 1 (R1) assessed to move to a higher level of care, but the assessment never happened. R1 experienced a cognitive decline and Administrator confirmed R1 was showing signs of Mild Cognitive Impairment (MCI). R1’s updated physician’s report dated 3/22/2021 lists R1’s primary diagnosis as dementia. R1 moved out of the facility on 4/5/2021. The Administrator at the time of this complaint, Stephanie Radu, confirmed no re-appraisals were conducted for R1. Administrator stated R1 was moved before the re-appraisals were done. Based on the information obtained, the facility did not conduct a reappraisal of R1 after receiving information of a diagnosis of dementia on the updated physician’s report.
Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
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 5
Control Number 29-AS-20210917135203
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: 12/21/2023
NARRATIVE
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Administrator admitted they were unable to conduct the reappraisal before the resident moved out, although there were two weeks between the diagnosis and the resident moving out. Therefore the allegation is deemed Substantiated at this time.

On the allegation: Staff did not follow physician's orders for resident's meals. It was alleged that Resident 1 (R1) had a special diet to have food cut up by staff due to poor hand functioning, but this did not happen and therefore R1 could not eat. According to multiple responsible parties interviewed, staff did not follow special diets for residents who required food to be chopped, resulting in residents not eating. Per R1’s responsible party, R1 lost a significant amount of weight, of about 50lbs in one year. R1’s reappraisal on 6/29/2020 states they are independent with dining assistance and has a regular diet (no special diet). The reappraisal was signed by the resident on 6/29/2020. Weight records for the facility indicate R1 weighted 197 lbs on 6/1/2019, 197 lbs on 12/28/2019, 184 lbs on 6/29/2020, R1’s physician’s report dated 8/4/2020 indicates R1 weighed 178 lbs, and facility weight records show 185 lbs on 3/12/2021. LPA was unable to verify that the resident lost a large amount of weight (the 50 lbs that was alleged). R1’s updated physician’s report dated 3/22/2021 indicates R1 had a special diet “unable to cut own food or open juice boxes.” R1 moved out of the facility on 4/5/2021. Administrator Stephanie Radu admitted they facility did not conduct a reappraisal of R1 before R1 moved out, therefore the new order for cut food was not implemented. Based on the information obtained, the allegation is deemed Substantiated at this time.

Deficiencies cited on 9099-D, report and appeal rights issued via certified mail.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20210917135203
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: 12/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/21/2023
Section Cited
CCR
87555(b)(7)
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87555(b)(7) General Food Service Requirements. Modified diets prescribed by a resident's physician as a medical necessity shall be provided. This requirement was not met as evidenced by:
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Facility is closed.
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Based on interviews and record review, the licensee did not comply with the section cited above when they did not update R1’s appraisal/care plan after a physician ordered cut food and the order was not implemented, which posed a potential health and safety risk to resident in care.
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Type B
12/21/2023
Section Cited
CCR
87463(c)
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87463(c) Reappraisals. The licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff…when there is significant change in the resident’s condition…This requirement was not met as evidenced by:
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Facility is closed.
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Based on interviews and record review, the licensee did not comply with the section cited above when they did not complete a reappraisal of R1 after updated physician’s report with new diagnoses and needs, which posed a potential health and safety 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: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
09/17/2021 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20210917135203

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:0CENSUS: 0DATE:
12/21/2023
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:TIME COMPLETED:
09:20 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not meet Resident’s daily needs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Olson mailed findings to the licensee for this investigation, as the facility closed and underwent a change of ownership effective 3/24/2023. During the investigation, LPA Kontilis toured the facility, reviewed relevant documents, and conducted interviews with staff and responsible parties.

On the allegation: Staff did not meet Resident’s daily needs. It was alleged that Resident 1 (R1) lost 50 lbs at the facility in 2020, that led to R1 tripping over their pants. R1’s reappraisal on 6/29/2020 states they are independent with dining assistance, can transfer and walk independently, and was not an identified fall risk. The reappraisal was signed by the resident on 6/29/2020. Weight records for the facility indicate R1 weighted 197 lbs on 6/1/2019, 197 lbs on 12/28/2019, 184 lbs on 6/29/2020, R1’s physician’s report dated 8/4/2020 indicates R1 weighed 178 lbs, and facility weight records show 185 lbs on 3/12/2021.

Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20210917135203
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: 12/21/2023
NARRATIVE
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LPA reviewed an incident report for 10/8/2020 that states R1 had a witnessed fall while walking through the gym area, and the resident fell and hit their head; emergency medical attention was sought by the facility but the resident refused to be transported. The incident report does not indicate the fall could have been caused by tripping on pants that were too big. It was also alleged that resident had a severe Urinary Tract Infection (UTI) that led to hospitalization. It was also alleged that on 3/12/2021, R1 was found sitting on their toilet unable to get up with no staff around. R1’s physician’s report dated 8/4/2020 indicates no bladder or bowel impairment, but states “assist” for toileting needs along with all other Activities of Daily Living. R1’s reappraisal dated 6/29/20020 indicates R1 is independent for toileting and states “resident does not require assistance with toileting” and indicates resident is continent. The reappraisal was signed by the resident on 6/29/2020. LPA reviewed an incident report for R1, that states on 7/17/2020 R1 was found on the floor of their room next to the bed by a kitchen staff/server. R1 told the staff they were fine and they did not need help. A caregiver responded to the room and found R1 had removed their pants and was unable to stand. Staff called 9-1-1. R1 was found to have a UTI while at the hospital. LPA was unable to find evidence corroborating no staff assisted R1 on 3/12/2021. Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore it is deemed Unsubstantiated at this time.

Report issued via certified mail due to facility closure.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5