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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425801016
Report Date: 08/09/2022
Date Signed: 08/12/2022 04:15:37 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
05/24/2021 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20210524124919
FACILITY NAME:VILLA RIVIERAFACILITY NUMBER:
425801016
ADMINISTRATOR:CAROL PRAGERFACILITY TYPE:
740
ADDRESS:1621 GRAND AVENUETELEPHONE:
(805) 568-5840
CITY:SANTA BARBARASTATE: CAZIP CODE:
93103
CAPACITY:20CENSUS: DATE:
08/09/2022
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Carol Prager, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility staff did not ensure that medications were inaccessible to residents in care.
Facility staff do not have adequate training to provide medications.
(these allegations were amended due to an error).
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Olson conducted a subsequent complaint visit to deliver findings for the above allegation. LPA met with Carol Prager, Administrator and explained the reason for the visit. During the investigation, LPA Toan Luong interviewed staff on 6/2/2021 and 6/14/2021, and reviewed incident reports from May and June 2021.

On the allegation: Facility staff did not ensure that medications were inaccessible to residents in care. According to an incident report, on 5/16/2021 there was an empty medication cup on the table in front of Resident 1 (R1), but the cup had Resident 2 (R2)’s name it. The incident report states the cup of medications for R1, and labeled for R1, was still on the medication cart. The incident report states “it appeared that resident [R1] got another resident’s meds.” Facility staff took R1’s vitals and informed the on-call nurse. The nurse called the on-call physician and notified them of the medications R1 ingested. The physician stated not to worry and instructed that R1 should take their routine medications.
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: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022
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 4
Control Number 29-AS-20210524124919
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: VILLA RIVIERA
FACILITY NUMBER: 425801016
VISIT DATE: 08/09/2022
NARRATIVE
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R1’s responsible party was contacted. R1 was observed by staff and was observed to have no adverse affects. The incident report stated the staff who provided R1 the wrong medications will take additional medication training. The Assistant Administrator stated the error occurred due to distraction. Assistant Administrator stated 5 items need to be check three times prior to providing medication: dosage, time, medication, route, and patient. Assistant Administrator confirmed the staff was re-trained and received additional medication training. Based on the information obtained, the allegation is deemed Substantiated at this time.

On the allegation: Facility staff do not have adequate training to provide medications. On 05/16/2021, staff gave Resident #1 (R1) the wrong medication. Staff #1 (S1) gave Resident #2’s (R2) over the counter (OTC) medication to R1 in error. The facility self-reported the incident and was cited on a separate report. Due to the medication error, the complainant/reporting party alleged that the staff did not have adequate medication training. On 06/02/2021, LPA Toan Luong obtained copies of staff training records for the period of March 2019 through April 2021. A review of the records revealed that the staff received training from the Administrator, who is also an RN, on various topics including medication. In-service medication training was noted on 03/28/2019 for 1 hour and on 12/19/2019 for 1.5 hours. Based on the medication training requirements for a facility licensed to provide care for 16 or more residents, the staff who assist residents with self-administration of medications are required to complete 24 hours of initial medication training and 8 hours of medication training annually thereafter. Based on the information obtained and reviewed, the allegation “Facility staff do not have adequate training to provide medications” is deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 9099-D).

Exit interview conducted, appeal rights discussed, and a copy of this report, appeal rights and 9099-D was emailed to Administrator.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20210524124919
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: VILLA RIVIERA
FACILITY NUMBER: 425801016
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/10/2022
Section Cited
CCR
87465(c)(2)
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87465(c)(2) Incident Medical and Dental Care. Once ordered by the physician the medication is given according to the physician's directions.

This requirement was not met as evidenced by:
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Administrator ensured staff was retrained on medications. Administrator agreed to submit proof S1 underwent medication training by 8/10/22
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Based on record review and interview, the licensee did not comply with the section cited above. Licensee failed to provide the correct medications to R1, which posed an immediate health and safety risk to residents in care.
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Type A
08/10/2022
Section Cited
HSC
1569.69
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§1569.69 Employees assisting residents with self-administration of medication; training requirement (a) Each residential care facility for the elderly licensed...shall ensure that each employee...who assists residents with... medications...facilities licensed to provide care for 16 or more...shall complete 24 hours of initial training.
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Licensee to submit plan how you will ensure staff who assist with medications receive the required initial and ongoing medication training. Submit plan along with proof of training by 8/10/22
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This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above. Licensee failed to provide the required initial and ongoing medication training, which posed an immediate 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: 08/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4
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
05/24/2021 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20210524124919

FACILITY NAME:VILLA RIVIERAFACILITY NUMBER:
425801016
ADMINISTRATOR:CAROL PRAGERFACILITY TYPE:
740
ADDRESS:1621 GRAND AVENUETELEPHONE:
(805) 568-5840
CITY:SANTA BARBARASTATE: CAZIP CODE:
93103
CAPACITY:20CENSUS: DATE:
08/09/2022
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility Administrator does not demonstrate the qualifications required of the position.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Olson conducted a subsequent complaint visit to deliver findings for the above allegation. LPA met with Carol Prager, Administrator and explained the reason for the visit. During the investigation, LPA Toan Luong interviewed staff on 6/2/2021 and 6/14/2021, and reviewed incident reports from May and June 2021.

On the allegation: Facility Administrator does not demonstrate the qualifications required of the position. The Reporting Party (RP) was concerned with the Administrator’s demeanor and how the Administrator interacted with responsible parties. Between 8/26/21 through 10/1/21, LPA Luong interviewed staff and residents' responsible parties. On 4/4/22, LPA Luong interviewed residents at the facility. Interviews conducted during that time did not reveal that staff spoke inappropriately towards residents. Interviews revealed that the demeanor of the Administrator was blunt and not tactful in some instances. However, the Administrator currently meets the qualifications of an Administrator. Based on the information obtained, the allegation is deemed Unsubstantiated at this time. Exit interview conducted, report emailed to Administrator/Licensee.
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: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4