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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425801016
Report Date: 10/05/2022
Date Signed: 10/06/2022 08:09:48 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
06/10/2021 and conducted by Evaluator Kristin Kontilis
COMPLAINT CONTROL NUMBER: 29-AS-20210610123242
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: 7DATE:
10/05/2022
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Carol Prager, AdministratorTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Illlegal Eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kristin Kontilis conducted a subsequent complaint visit to deliver findings for the above allegation. LPA met with Carol Prager and explained the purpose of the visit. During the investigation, LPA conducted interviews with responsible parties, staff, and medical personnel and reviewed relevant documents.
On the allegation: Illegal eviction. LPA interviewed Responsible Party 1 (RP1), who indicated the Administrator verbally informed RP1 on 6/3/2021 that R1 was not a fit for the facility and would have to move. According to RP1, the Administrator stated that R1 needs memory care and RP1 agreed. RP1 stated they asked if R1 could live at the facility until R1 was accepted somewhere else and the Administrator agreed. LPA reviewed an email sent on 6/9/2021 at 3:45 pm from the Administrator to RP1 regarding Resident 1 (R1). The Administrator indicates there was an incident where R1 tried to remove wedding rings from the hand of another resident. The Administrator states they are providing a list of memory care facilities, and with R1’s continuing behaviors, a move would be better sooner than later.
Please continue to 9099-C, Pg 2.
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: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022
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 5
Control Number 29-AS-20210610123242
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: 10/05/2022
NARRATIVE
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The Administrator states “We are willing to keep [R1] at Villa until the end of June as long as [their] behavior does not escalate.” LPA reviewed documents and found that no written eviction letter was created by the Administrator, nor given to RP1 or CCL. LPA confirmed the facility accepts residents who have dementia and has a plan of operation for dementia.
On 7/21/2022, LPA interviewed Administrator who stated even though they accept residents with dementia, they are not a “memory care facility,” which is an invalid statement. Based on the information obtained, the Administrator did not provide a valid, written eviction notice for R1. Therefore the allegation is Substantiated at this time. LPA counseled Administrator about the definition of higher level of care and acceptance and retention of residents.

Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 9099-D).
Exit interview conducted. Copy of report and Appeal Rights issued via email.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20210610123242
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: 10/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/06/2022
Section Cited
CCR
87224(c)
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87224(c) Eviction Procedures: The licensee shall, in addition to either serving the required thirty (30) days notice, sixty (60) days notice…notify or mail a copy of the notice to quit to the resident's responsible person.

This requirement is not met as evidenced by:
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Administrator agrees to submit a written statement acknowledging understanding of 87224 in its entirety by 10/6/2022.
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Based on interviews and record review, the licensee did not comply with the section cited above. Licensee/Administrator failed to issue a 30-day written notice to R1, only gave a verbal notice, 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: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022
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
06/10/2021 and conducted by Evaluator Kristin Kontilis
COMPLAINT CONTROL NUMBER: 29-AS-20210610123242

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: 7DATE:
10/05/2022
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Carol Prager, AdministratorTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility did not follow Doctor's orders in discontinuing medication.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kristin Kontilis conducted a subsequent complaint visit to deliver findings for the above allegation. LPA met with Carol Prager and explained the purpose of the visit. During the investigation, LPA conducted interviews with responsible parties, staff, and medical personnel, and reviewed relevant documents.
On the allegation: Facility did not follow Doctor's orders in discontinuing medication. LPA interviewed RP1, Physician’s Assistant, and Administrator. On Wednesday, 6/2/2021, RP1 returned R1 to the facility following a doctor’s appointment. RP1 informed the Administrator that R1’s physician discontinued R1’s Eliquis medication. The Administrator told RP1 they would need the discontinue order in writing before implementing the change. On Friday, 6/4/2021, a Physician’s Assistant for R1’s physician attempted to obtain a fax number at the facility to provide a discontinue order for R1’s Eliquis medication.
Please continue to 9099-C, Pg 2.
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: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022
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-20210610123242
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: 10/05/2022
NARRATIVE
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The Administrator stated they did not receive the fax and provided an additional fax number. The Physician’s Assistant communicated to RP1 they tried to fax the order to the facility twice on 6/4/2021. The Administrator stated the doctor’s office closed early on Friday, and the Physician’s Assistant confirmed the office was closed over the weekend. O
n Monday, 6/7/2021, the Administrator texted RP1 and stated they still did not have the discontinue order. The Administrator stated they waited for the written order per regulations, and were not able to obtain it in time despite their attempts. On 6/7/2021, the discontinue order was received and the medication was discontinued. Based on the evidence obtained, the allegation is deemed Unsubstantiated at this time. CCL recommends that the Administrator determine if any improvements can be made to their process of obtaining/updating written doctor’s orders to implement them as soon as possible.

Exit interview conducted. Copy of report issued via email. No deficiencies noted at this time.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5