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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425801995
Report Date: 07/16/2021
Date Signed: 07/16/2021 06:39:26 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
07/09/2021 and conducted by Evaluator Kristin Kontilis
COMPLAINT CONTROL NUMBER: 29-AS-20210709080012
FACILITY NAME:ALEXANDER GARDENSFACILITY NUMBER:
425801995
ADMINISTRATOR:LEICHTER, MITCHELLFACILITY TYPE:
740
ADDRESS:2120 SANTA BARBARA STTELEPHONE:
(805) 682-9644
CITY:SANTA BARBARASTATE: CAZIP CODE:
93105
CAPACITY:36CENSUS: 25DATE:
07/16/2021
UNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Dalia Gutierrez, Business Office ManagerTIME COMPLETED:
05:40 PM
ALLEGATION(S):
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Facility restricted visitation.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kristin Kontilis made an unannounced initial 10-Day complaint visit. LPA arrived at the facility at 12:10 pm, and met with Dalia Gutierrez, Business Office Manager to announce the purpose of the visit. Gutierrez stated Joseph Newlan, Administrator was on vacation and not available at this time.

Entrance interview conducted.
From 1:30 pm – 4:40 pm, LPA conducted in-person interview(s) and obtained copies of documents pertaining to the investigation.
On the allegation that facility restricted visitation, interviews conducted and documents reviewed revealed that residents were allowed visitors on Tuesdays, Thursdays, Fridays, and Sundays at 11:30 am, 1:30 pm, and 3:30 pm with only two (2) visitors at a time by appointment only. Therefore, the allegation that the facility restricted visitations is Substantiated at this time.
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: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
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-20210709080012
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: ALEXANDER GARDENS
FACILITY NUMBER: 425801995
VISIT DATE: 07/16/2021
NARRATIVE
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Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D):
Exit interview conducted, copy of report issued. Appeal Rights issued.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20210709080012
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: ALEXANDER GARDENS
FACILITY NUMBER: 425801995
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/16/2021
Section Cited
CCR
87468.1(a)(11)
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87468.1(a)(11) Personal Rights of Residents in All Facilities: To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon.
This requirement is not met as evidenced by:
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Business Office Manager removed visitation notice on main door immediately upon request. LPA reviewed CCLD Provider Information Notice (PIN) 21-17.2-ASC w/Business Office Manager. Business Office Manager agrees to notify via email all residents' visitors and potential visitors of visitation policy per PIN 21-17-.2-ASC. Business Manager agrees to
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Based on records reviewed and interviews conducted, each resident may have two visitors at a time on Tuesdays, Thursdays, Fridays, and Sundays at 11:30 am, 1:30 pm, and 3:30 pm for 30 minutes by appointment only. This is a personal rights violation and poses an immediate health and safety risk to residents in care.
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provide LPA a copy of the email once it has been sent to Residents visitors and potential visitors. Business Manager agrees to verbally announce to all residents new visitation policy.
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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: 07/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4