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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425802106
Report Date: 07/12/2024
Date Signed: 07/12/2024 12:45:03 PM


Document Has Been Signed on 07/12/2024 12:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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 BARBARAFACILITY NUMBER:
425802106
ADMINISTRATOR:MARK CORTESFACILITY TYPE:
740
ADDRESS:190 VIAJERO DRTELEPHONE:
(805) 265-4327
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:99CENSUS: 67DATE:
07/12/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:Ernest "EJ" Lewis, Interim AdministratorTIME COMPLETED:
12:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced case management visit to issue additional deficiencies discovered while investigating complaints at this facility. LPA met with Ernest “EJ” Lewis and explained the purpose of the visit. During the investigation, LPA Kontilis reviewed relevant documents and interviewed staff.

During the investigation of complaint 29-AS-20240515122500, it was alleged that Resident 1 (R1) did not receive their eyedrops as prescribed. Staff interviewed indicated R1 sometimes refused their eyedrops. LPA reviewed Medication Administration Records (MARs) for R1 from September 2023 to March 2024. LPA observed different reasons documented for resident not receiving medications. For eyedrops specifically, LPA observed several dates where R1 did not receive their eyedrops as prescribed, and reasons included “resident very sleepy,” “resident refused,” “physically unable to take – resident very sleepy,” “physically unable to take – resident in a deep sleep.”

LPA asked for documentation showing that the prescription eyedrop refusals were communicated to R1’s physician. LPA was provided only two documented cases where R1’s physician was notified of refused eye drops, on 4/18/2023 and 10/30/2022. The refusals also included other medications, and the refusal notice was sent to R1’s primary care physician, where they notated “thank you, no new orders.” Regulations require that any changes in the resident are documented and brought to the attention of the “resident’s physician.” The facility only notified R1’s primary care physician of two cases where the resident refused the medication, due to agitation per interviews. The facility did not notify R1’s physician when R1 did not take their medications due to being asleep, which occurred more times. Although the regulation does not specify which physician the changes should be brought to, Technical Assistance is provided to the facility to recommend that relevant specialists and prescribing physicians should also be notified of changes including medications not given, in addition to primary care physician’s.

The following deficiencies were observed (See LIC 809-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 provided
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/12/2024 12:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 07/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/15/2024
Section Cited
CCR
87466

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87466 Observation of the Resident. When changes…are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement was not met as evidenced by:
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Interim Administrator agrees to provide a written plan to ensure residents’ physicians are notified of medication refusals promptly and appropriately.
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Based on interview and record review, the licensee did not comply with the section cited when R1’s missed medications were not communicated to their physician, which posed an immediate health and safety risk to residents in care.
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Interim Administrator agrees to conduct in-service with staff to include procedures to follow with residents' medications refusals. Interim Administrator will inform CCLD as to date(s) in-services will be conducted.

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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: 07/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2024
LIC809 (FAS) - (06/04)
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