425802106-8-2-2023-29-AS-KBUY-CUCRS8-20230803131618

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802106
Report Date: 08/02/2023
Date Signed: 08/02/2023 04:33:52 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
07/28/2023 and conducted by Evaluator Kristin Kontilis

COMPLAINT CONTROL NUMBER: 29-AS-20230728161400

FACILITY NAME:	MARIPOSA AT ELLWOOD SHORES		FACILITY NUMBER:	425802106
ADMINISTRATOR:	MARK CORTES		FACILITY TYPE:	740
ADDRESS:	190 VIAJERO DR		TELEPHONE:	(805) 265-4327
CITY:	GOLETA	STATE: CA	ZIP CODE:	93117
CAPACITY:	99	CENSUS: 62	DATE:	08/02/2023
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Mark Cortes, Administrator		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff yell at residents.
Staff do not provide adequate food service for residents.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced initial 10-Day complaint visit to address the above-stated allegations. Administrator Mark Cortes became available at approximately 12:50 pm. LPA stated the purpose of the visit.
During the visit, LPA obtained documents pertaining to the investigation and interviewed 10 residents and 6 staff between 11:30 am and 2:45 pm.
Regarding the allegation “Staff yell at residents”, LPA interviewed Administrator who stated that if someone alleged a staff spoke inappropriately to residents, they would address it with the staff, put the staff member on a 3-day administrative leave, and contact the Corporate office to make them aware of the situation. Administrator stated that yelling or inappropriately speaking to a resident is a zero tolerance incident and it would be reported to Licensing as a personal rights violation.
Resident interviews conducted revealed that on one occasion a staff member was heard to tell a resident ‘they just had to wait’ when inquiring about their food order; and on one occasion a staff member was heard to tell a resident to “go and sit down”. The interviews revealed staff did not raise their voices to residents.
Please continue to 9099-C, Pg 2.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

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 2

Control Number 29-AS-20230728161400

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: MARIPOSA AT ELLWOOD SHORES	FACILITY NUMBER: 425802106
	VISIT DATE: 08/02/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Residents reported that staff are friendly towards the residents and often interact in a cheerful manner with “smiles on their faces”.
Interviews with staff members revealed that they never witnessed a staff member yelling or speaking sharply with a resident and if they did witness a staff member yelling or speaking harshly to a resident, it would be reported to their supervisor. One staff member stated that after reporting it to the supervisor, they would immediately console the resident.
Based on observation and interviews conducted, the allegation that staff yelled at a resident is Unsubstantiated at this time.

Regarding the allegation, “Staff do not provide adequate food service for residents”, it is alleged that the food is too spicey. Resident interviews conducted revealed that the spiciness of food has not been a concern for them. Three residents stated their concern is that sometimes food items listed on the menu are not available. Other residents interviewed revealed that they are satisfied with the food.
Staff members interviewed revealed that residents have not complained that the food is too spicy. One staff member stated if a resident complained that a food item is too spicy, they would offer something else off the menu. Upon interview conducted with the facility chef, the chef stated that cayenne pepper and jalapeno peppers are not used in the food menus. Facility chef also stated that there is an emphasis on the quality of the meals to entice the residents to eat well. Based on observation and interviews conducted, the allegation that Staff did not provide adequate food service is Unsubstantiated at this time.

Exit interview conducted. No deficiencies noted at this time. 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: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2