425801158-10-30-2024-29-AS-KBUY-DAJU2T-20241030151227

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425801158
Report Date: 10/30/2024
Date Signed: 10/30/2024 12:22:17 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
01/05/2024 and conducted by Evaluator Kristin Kontilis

COMPLAINT CONTROL NUMBER: 29-AS-20240105145048

FACILITY NAME:	MESA CARE		FACILITY NUMBER:	425801158
ADMINISTRATOR:	VALENTYNA POLUNETS		FACILITY TYPE:	740
ADDRESS:	2424 CALLE SORIA		TELEPHONE:	(805) 965-2428
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93109
CAPACITY:	6	CENSUS:	DATE:	10/30/2024
		UNANNOUNCED	TIME BEGAN:	10:17 AM
MET WITH:	Alex Polunets, Co-Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident had bruising as a result of neglect and/or rough handling.
Medication was not given as prescribed.
Staff did not meet resident’s needs.
Staff were rude to resident.
Resident’s personal rights were violated.
Facility is not providing activities.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Brian Phillips and Kristin Kontilis conducted a subsequent complaint visit to issue final findings on this investigation. During the investigation, LPA Kontilis conducted an initial visit on 1/9/2024 from 11:40 am to 4:00 pm. LPA toured the facility, conducted interviews, and obtained relevant documents. On 10/8/2024 from 9:30 am to 2:00 pm, LPA conducted additional interviews and noted observations during the annual visit to the facility.
On the allegation: Resident had bruising as a result of neglect and/or rough handling. It was alleged a resident had “defensive bruises” on their arms from “blocking.” The resident was also observed with a bruise to their left temporal area. Residents interviewed stated staff treat them like family, and there has been no rough handling. Residents interviewed stated staff had never been rough when assisting them, and all their needs were met. Staff interviewed stated they had never heard of nor witnessed residents’ personal rights being violated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time. Please continue to 9099-C, Pg 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

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 3

Control Number 29-AS-20240105145048

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: MESA CARE	FACILITY NUMBER: 425801158
	VISIT DATE: 10/30/2024

NARRATIVE

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On the allegation: Medication was not given as prescribed. It was alleged R1 is allowed to have 3 glasses of white wine per day, but then went to the hospital and was prescribed Valium. It was alleged the wine was stopped, then both the wine and medications were discontinued. R1 indicated staff assist them with medications. Licensee stated R1 wants to drink wine, but their physician has limited it to 3 glasses per day. Licensee stated they try to redirect the resident when they have not eaten much. Licensee stated the doctor never indicated they needed to stop allowing R1 to have wine and it is their right to have wine if they want it. Licensee further stated they try to work with R1 about their drinking habits and stick to the 3 glasses per day as approved by the doctor. Licensee stated they did not withhold the Valium. Other residents interviewed stated they receive assistance with medications. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.
On the allegation: Staff did not meet resident’s needs. It was alleged staff do not meet resident’s needs. A visitor was interviewed and stated R1 appeared “unkempt” and was not getting their required physical therapy appointments. During the visits, LPA did not observe any residents unkempt. During a visit, LPA observed R1 on the phone scheduling their own appointments. Licensee stated sometimes they will help R1 schedule or dial the phone when asked, but R1 is able to schedule them independently. Residents interviewed stated the staff meet their needs. Staff interviewed stated they assist residents with all activities of daily living that are needed and cater to each individual. Staff ensure residents needs are met by talking to them and their families to create a care plan. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.
On the allegations: Staff were rude to resident and Resident’s personal rights were violated. It was alleged staff were rude when speaking at dinnertime. A visitor indicated they observed staff being rude when a resident asked for food and was told dinner is at 5 pm; however, staff did feed the resident. Visitor stated some staff have an “Eastern European accent” and sounded rude. Some residents interviewed indicated sometimes staff are rude but did not elaborate. Residents interviewed stated on one occasion, the staff did not provide dinner because they were home late and said, “you must go to bed.” Upon re-interview the resident stated staff treat them like family, they use a calm voice, and staff yelled once but resident yells

Please continue to 9099-C, Pg 3.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20240105145048

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: MESA CARE	FACILITY NUMBER: 425801158
	VISIT DATE: 10/30/2024

NARRATIVE

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back. Resident stated people speak up because the resident’s “ears are clogged up.” Resident stated staff observe their personal rights and have never been rude. Residents interviewed stated staff were nice and they had no issues with personal rights. Another resident stated the staff would give them dinner if they were home late. Residents interviewed stated they can leave the facility when they want. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.
On the allegation: Facility is not providing activities. It was alleged residents are being isolated. LPA observed residents in the living room and at the dining table during visits. LPA observed music, puzzles, and games inside and outside the facility. Residents interviewed stated a musician comes once week, but there are few other activities. One resident initially stated there were no activities, but later stated they do their own activities like games, puzzles, and music on their own and go out of the facility with visitors. Residents stated they talk with each other a lot as an activity. During the visit, licensee was heard telling another resident they can go for a walk soon.
During today's visit, Licensee stated special celebrations are held for birthdays and all holidays including family members attending with decorations and special meals.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.

Exit interview conducted. Copy of report issued at the time of the visit.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC9099 (FAS) - (06/04)

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