425801937-7-13-2022-29-AS-KBUY-CGCSDF-20220715134704

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425801937
Report Date: 07/13/2022
Date Signed: 07/13/2022 03:23:01 PM

Unfounded

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
07/07/2022 and conducted by Evaluator Kristin Kontilis

COMPLAINT CONTROL NUMBER: 29-AS-20220707163011

FACILITY NAME:	MARAVILLA		FACILITY NUMBER:	425801937
ADMINISTRATOR:	GRANDE, RUTH E		FACILITY TYPE:	740
ADDRESS:	5486 CALLE REAL		TELEPHONE:	(805) 967-1965
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93111
CAPACITY:	131	CENSUS:	DATE:	07/13/2022
		UNANNOUNCED	TIME BEGAN:	01:44 PM
MET WITH:			TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Staff did not respond timely to a resident's call button.
Staff did not seek timely medical attention to a resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kristin Kontilis conducted an initial 10-day complaint visit to address the allegations as stated above. LPA met with Ruth Grande, Administrator and explained the purpose of the visit. On 7/11/2022 and 7/12/2022, LPA interviewed the reporting party, who noted issues with Person 1 (P1)’s call button and staff not seeking timely medical attention. During the call, it was determined P1 does not live in the licensed/Assisted Living portion of the facility; rather P1 lives in the Independent Living section on the same property which is not licensed by Community Care Licensing Division (CCLD) and does not provide care and supervision to residents in Independent Living. During the visit, LPA viewed a resident roster and confirmed P1 does not reside in Assisted Living or Memory Care.
Based off the information obtained, the allegation is deemed Unfounded at this time because P1 does not reside in a facility licensed by CCLD. A finding of “Unfounded” means that the allegation is either false, could not have happened, and/or is without a reasonable basis.
Exit interview conducted, report issued via email.

Unfounded

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: 07/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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