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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425800837
Report Date: 05/04/2021
Date Signed: 05/04/2021 03:21:24 PM



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
08/13/2019 and conducted by Evaluator Lyndia Sager
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20190813113112
FACILITY NAME:GARDEN COURT AT VILLA SANTA BARBARAFACILITY NUMBER:
425800837
ADMINISTRATOR:JOE A. FRANKENFACILITY TYPE:
740
ADDRESS:227 E. ANAPAMU STREETTELEPHONE:
(805) 963-4428
CITY:SANTA BARBARASTATE: CAZIP CODE:
93101
CAPACITY:126CENSUS: 62DATE:
05/04/2021
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Stephania Radu, AdministratorTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Facility staff are not following resident's care plan.
Due to facility being short staffed, facility staff are not meeting the needs of the residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lyndia Sager conducted a subsequent complaint investigation to deliver final investigation findings telephonically with Stephania Radu, Administrator, due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures.

On 08/20/2019 Licensing Program Analysts (LPAs) Mark Jeffries and Kristin Kontilis conducted a 10-day initial visit from 11:50 a.m. to 5:30 p.m. and obtained documents pertinent to the allegations. During the visit, interviews were conducted with two residents and two staff from 1:05 p.m. to 3:11 p.m. On 08/12/2019 from 9:30 a.m. to 10:15 a.m. LPA Jeffries conducted additional interviews with five residents related to an 08/09/2019 complaint investigation #29-AS-20190809084836. The information obtained is also relevant to the current 08/13/2019 complaint allegations listed above.

see next page (9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Lyndia SagerTELEPHONE: (805) 680-7683
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021
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 4
Control Number 29-AS-20190813113112
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: 05/04/2021
NARRATIVE
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On 04/15/2021 at 3:09 p.m., 04/21/2021 at 11:07 a.m., 04/23/2021 at 8:38 a.m., and 04/29/2021 at 8:24 a.m. - LPA Sager requested and reviewed pertinent staff and resident documents relating to the above allegations. On 4/15/2021 from 3:09 p.m. to 3:48 p.m. LPA conducted an interview with the Administrator. On 04/15/21 from 4:17 p.m. to 4:46 p.m. LPA conducted an interview with the former Director of Nursing. On 04/16/21 from 04:21 p.m. to 4:38 p.m. LPA conducted an interview with Resident #1 (R1) family member. On 04/21/2021 from 12:14 p.m. to 3:07 p.m. and 04/23/21 at 10:30 a.m. LPA conducted interviews with seven staff. On 04/23/2021 at 11:15 a.m. LPA conducted an interview with the current Wellness Director. On 04/27/2021 at 12:55 p.m. LPA conducted an interview with Hospice nurse. On 04/27/21 at 10:06 a.m. LPA conducted an interview with Resident #2 (R2).

Per Administrator Radu, there had been management staffing changes since the previous Administrator left in May 2019, and an interim Administrator was in place until she was hired 07/17/2019. Based on information obtained from Administrator Radu and review of hospice documents, (R1) was on hospice prior to 07/17/19. (R1) was placed on hospice 5/16/2018 - 08/10/2018 and 6/14/2019 - 1/27/2021. LPA reviewed the hospice care plan and notes which indicated (R1) was bathed twice per week and assisted with feeding three times per week. Facility did not provide LPA with any documentation of shower/bath logs that the facility staff were providing baths during the days that hospice was not visiting (R1). Administrator provided a document which states “Your weekly showers will be offered every Tuesday and Friday by Hospice and as needed by care staff at our Wellness Department”. (There is no date when the notice was created or indication of where it would have been posted). LPA reviewed the Facility Care Assessment Plan for (R1) dated 05/16/2019 which states “Bathing Level of Assistance - Total: Resident is dependent on others to provide complete bath, including shampoo, 1 to 2 times weekly”. Information obtained through staff interviews revealed that when (R1) was on hospice, hospice took care of the bathing.

Based on information obtained through resident and staff interviews, there was not an adequate amount of staff to meet the needs of residents in a timely manner. Some residents have had to wait over 30 minutes for assistance from staff. LPA reviewed the printed staff schedule for 08/04/2019 – 08/18/2019. The schedule shows one med tech for a.m. and p.m. shift, three staff for a.m. and p.m. shift and two staff for overnight shift (except August 4, 8, 11, 15 shows only one staff for the overnight shift). The handwritten schedule for the same dates shows staff were off some of the days that the printed schedule shows that they worked. LPA reviewed the LIC500 Personnel Report dated 08/15/2019 shows one med tech for Sun – Thurs 6:00 a.m. to 2:30 p.m. and one med tech for Sun – Tues 6:00 a.m. to 2:30 p.m. and Thurs 6:00 a.m. to 2:30 p.m.

SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Lyndia SagerTELEPHONE: (805) 680-7683
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20190813113112
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: 05/04/2021
NARRATIVE
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The schedules reviewed are not consistent with each other. Per the Administrator, as of 08/20/19 the census was 108 with 38 Assisted Living residents.

Based on the information obtained during the course of the investigation, the above allegations are deemed substantiated.

Deficiencies issued on 9099-D, telephonic exit interview was conducted with the Administrator, and a copy of the report was provided via email for signature. Appeal Rights emailed.

SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Lyndia SagerTELEPHONE: (805) 680-7683
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20190813113112
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: 05/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/11/2021
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General
a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by:
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Licensee will submit plan on how you will ensure the facility has 24/7 adequate staffing and a plan for back up staffing to meet resident needs including following resident care plans. Submit plan to CCL by 05/11/2021.
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Based on interviews and documents reviewed, the licensee failed to ensure there was an adequate amount of staff to meet resident needs and follow the resident’s care plan, 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: Kristin HeffernanTELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Lyndia SagerTELEPHONE: (805) 680-7683
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4