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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425802106
Report Date: 06/17/2024
Date Signed: 06/21/2024 09:36:45 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
05/15/2024 and conducted by Evaluator Kristin Kontilis
COMPLAINT CONTROL NUMBER: 29-AS-20240515122500
FACILITY NAME:WESTMONT OF SANTA BARBARAFACILITY NUMBER:
425802106
ADMINISTRATOR:MARK CORTESFACILITY TYPE:
740
ADDRESS:190 VIAJERO DRTELEPHONE:
(805) 265-4327
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:99CENSUS: 69DATE:
06/17/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Sheryl McCaskill, Interim AdministratorTIME COMPLETED:
06:30 PM
ALLEGATION(S):
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Staff did not provide residents personal representative with copy of resident's records.
Staff did not ensure residents room was kept in clean sanitary conditions.
Staff did not ensure residents room was free of mal odors.
Facility staff did not safeguard resident's personal belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced complaint visit to issue final findings on the allegations above. LPA met with Sheryl McCaskill to issue the final findings. During the investigation, LPA Kontilis conducted a visit on 5/21/2024 from 10:00 am to 5:30 pm to interview staff and residents and obtain relevant documents. LPA also conducted interviews on 6/14/2024 and 6/17/2024.
On the allegation: Staff did not provide residents personal representative with copy of resident's records. It was alleged that a personal representative was not provided a copy of the resident’s records. Responsible Party (RP) for Resident 1 (R1) stated they asked the now former administrator for a copy of R1’s resident records multiple times via email and once in person. Per RP, the former administrator indicated the facility no longer releases records in order to protect the identify of the caregivers. LPA observed an email dated 1/22/2024 to facility management asking for R1’s records, and additional emails dated 1/30/2024 and 3/19/2024 asking for the records. An email from 3/4/2024 from RP to facility management indicates the

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: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024
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 7
Control Number 29-AS-20240515122500
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: WESTMONT OF SANTA BARBARA
FACILITY NUMBER: 425802106
VISIT DATE: 06/17/2024
NARRATIVE
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facility provided R1’s recent history, physician’s reports, medication list, and advanced healthcare directive. However, the facility did not give a complete copy of R1’s records to their responsible party as requested. Based on the information obtained, the allegation is deemed Substantiated at this time.
On the allegations: Staff did not ensure resident’s room was kept in clean sanitary conditions, and Staff did not ensure resident’s room was free of mal odors. LPA reviewed photographs obtained by Resident 1’s (R1’s) responsible party (RP). RP stated when RP visited R1 in R1’s room on 12/31/2023, feces were observed on the wall of R1’s room. RP indicated R1 had a behavior of throwing their brief at the wall. LPA observed photographs of numerous brown marks all over a wall but did not observe any during the visit on 5/21/2024. RP stated feces was observed in R1’s room on 12/31/2024 which caused a mal odor in the room. RP stated they conducted a walk through with now former Administrator on 4/23/2024 at which time RP observed the feces on the wall was “dried and still present” and stated the feces seemed to be dry enough to not present a mal odor. During the visit on 5/21/2024, LPA toured the “Compass Rose” memory care unit of the facility with Staff 1 (S1). At approximately 2:00 pm, LPA observed a mal odor in the common area of the memory care unit, of urine and feces. LPA brought the odor to S1’s attention, and S1 stated “I smell it too.” Based on interview conducted and documents obtained, the allegation that Staff did not ensure resident’s room was kept in clean sanitary conditions is deemed Substantiated at this time.
On the allegation, facility staff did not safeguard resident’s personal belongings, RP stated R1 had many personal belongings such as but not limited to scarves, clothing, sheets, bedspread, a doll, and pillows. RP noted one scarf that was missing was worn by a staff member, who stated a resident gave them the scarf. RP further stated when R1’s coats, jackets, and other clothing articles were returned from being laundered, many of the items had been “ruined” due to having been put through a washer and/or dryer when they were not the type of fabrics that should have been washed and/or dried. RP provided email communications between facility staff and RP inquiring about missing and damaged items. RP also noted when R1 was moving out, RP discovered several items in R1’s room that did not belong to R1. During the visit on 5/21/2024, LPA conducted interviews with residents. Resident 2 (R2) stated their clothing and laundered items were not returned after several days. Resident 3 (R3) stated personal clothing items such as shirts were either being washed in too hot of water or dried at too hot of a temperature because the shirts are getting “shorter and shorter”. R3 also stated a furniture item was damaged when facility staff moved R3 into a different room. During today’s visit, LPA conducted an interview with R3’s Responsible Party. R3’s

Please continue to 9099-C, Pg 3.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 29-AS-20240515122500
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: WESTMONT OF SANTA BARBARA
FACILITY NUMBER: 425802106
VISIT DATE: 06/17/2024
NARRATIVE
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Responsible Party confirmed R3’s chair was broken as a result of R3’s move. The investigation revealed that some items went missing; and also that facility staff damaged multiple items belonging to residents. Based on records reviewed and interviews conducted, the allegation “Facility staff did not safeguard resident’s personal belongings” is deemed Substantiated at this time.

The following deficiencies were observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in additional civil penalties.

Exit interview conducted. A copy of the report and appeal rights were issued at the time of the visit.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 29-AS-20240515122500
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: WESTMONT OF SANTA BARBARA
FACILITY NUMBER: 425802106
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/24/2024
Section Cited
CCR
87468.2(a)(19)
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87468.2(a)(19) Personal Rights. To have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided within two (2) business days…This requirement was not met as evidenced by:
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Administrator agrees to provide R1’s responsible party a complete copy of R1’s records by 6/24/2024.
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Based on interview and record review, the licensee did not comply with the section cited above when they did not provide R1’s responsible party access to all of R1’s records, which posed a potential personal rights risk to residents in care.
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Type B
06/24/2024
Section Cited
CCR
87303(a)
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87303(a) Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times.

This requirement was not met as evidenced by:
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R1’s wall has been cleaned. Administrator agrees to provide proof of deep cleaning in memory care by 6/24/2024.
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Based on interview and observation, the licensee did not comply with the section cited above when the facility had a mal odor and feces on R1’s wall, which posed a potential health 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: 06/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 29-AS-20240515122500
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: WESTMONT OF SANTA BARBARA
FACILITY NUMBER: 425802106
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/24/2024
Section Cited
CCR
87218(a)(2)
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87218(a)(2) Theft and Loss: A licensee who fails to make reasonable efforts to safeguard resident property, shall reimburse a resident for or replace stolen or lost resident property at its current value. This requirement was not met as evidenced by:
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Administrator agrees to reimburse residents for damaged items. Administrator agrees to submit a written statement of understanding of 87218 to CCL by 6/24/2024.
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Based on interview, the licensee did not comply with the section cited above, as they were unable to properly safeguard resident property, which poses a potential personal rights 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: 06/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7
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
05/15/2024 and conducted by Evaluator Kristin Kontilis
COMPLAINT CONTROL NUMBER: 29-AS-20240515122500

FACILITY NAME:WESTMONT OF SANTA BARBARAFACILITY NUMBER:
425802106
ADMINISTRATOR:MARK CORTESFACILITY TYPE:
740
ADDRESS:190 VIAJERO DRTELEPHONE:
(805) 265-4327
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:99CENSUS: 69DATE:
06/17/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Sheryl McCaskill, Interim AdministratorTIME COMPLETED:
06:30 PM
ALLEGATION(S):
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Staff allowed resident to be in soiled clothing for extended periods of time.
Staff did not ensure medications were dispensed as prescribed to residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced complaint visit to issue final findings on the allegations above. LPA met with Sheryl McCaskill, Interim Administrator to issue the final findings. During the investigation, LPA Kontilis conducted a visit on 5/21/2024 from 10:00 am to 5:30 pm to interview staff and residents and obtain relevant documents. LPA also conducted interviews on 6/14/2024 and 6/17/2024.

On the allegation: Staff allowed resident to be in soiled clothing for extended periods of time. Reporting Party stated the staff did not ensure R1 was kept in clean, dry clothing and left R1 in soiled diapers for an extended period of time. Residents interviewed stated their care needs were met, and they were never left soiled for an extended period of time. Some indicated staff were extra busy at times. All staff interviewed stated caregivers were on top of things, and they attend to soiled residents right away. All staff stated
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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: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 29-AS-20240515122500
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: WESTMONT OF SANTA BARBARA
FACILITY NUMBER: 425802106
VISIT DATE: 06/17/2024
NARRATIVE
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residents are checked every two hours and changed as needed. Some residents noted they had difficulty communicating with the staff because they do not speak English, but they try to communicate through gestures. Technical assistance is provided to remind the licensee of their responsibility to have competent staff that can communicate appropriately with residents. Although the allegation may have occurred, there was insufficient evidence to prove it; therefore, the allegation is deemed Unsubstantiated at this time.

On the allegation: Staff did not ensure medications were dispensed as prescribed to residents in care. It was alleged that staff did not provide R1 their eye drops to them as prescribed. It was alleged R1 moved out of the facility and had 3 to 5 extra bottles of eye drops. If R1 had received them as prescribed, they should not have so many extra bottles. Staff stated sometimes R1 refused the eye drops, which could account for the extra bottles over the years R1 lived at the facility, as the eye drops were auto-refilled by the pharmacy regardless if they were empty or not. LPA reviewed centrally stored medication records for the facility and medication lists that showed R1’s eye drop medications. However, R1 moved out of the facility in April 2024, and the eye drops were no longer at the facility and could not be reviewed. Based on the information obtained, there was insufficient evidence to prove the allegation occurred. Therefore it is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report issued at the time of the visit.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7