425802114-6-16-2023-29-AS-KBUY-CT7QB3-20230627120053

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802114
Report Date: 06/16/2023
Date Signed: 06/16/2023 02:43:49 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
11/09/2021 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20211109115649

FACILITY NAME:	GRANVIDA SENIOR LIVING AND MEMORY CARE		FACILITY NUMBER:	425802114
ADMINISTRATOR:	KAWANA ANTHONY		FACILITY TYPE:	740
ADDRESS:	5464 CARPINTERIA AVE		TELEPHONE:	(805) 566-0017
CITY:	CARPINTERIA	STATE: CA	ZIP CODE:	93013
CAPACITY:	83	CENSUS: 41	DATE:	06/16/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Eric Terrell, Executive Director		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

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Facility did not provide medical attention.
Facility does not have adequate supplies for resident(s).
Facility did not meet Resident's/Residents' care needs.
Facility did not report incident of serious illness/injury.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted an unannounced subsequent complaint visit to issue final findings on the allegations above. LPA Kontilis conducted the 10 day visit, requested relevant documents, interviewed reporting party on 11/9/21. LPA Olson interviewed previous staff who worked at the facility during the time of this complaint on 5/9/2023 and 5/12/23, and residents on 6/16/23. LPA met with Executive Director and explained the purpose of the visit.

On the allegation: Facility did not provide medical attention. It was alleged that facility staff would not send residents to the hospital. Reporting Party stated Resident 1 (R1) allegedly had poor health on 11/4/21-11/6/21 and didn’t go to the hospital until 11/7/21 when staff called 9-1-1. LPA interviewed staff who stated they notified the nurse that R1 had their head down, was drooling, and not able to keep food in their mouth. Staff said the Nurse told them to notify the POA before calling 9-1-1. Staff also stated Resident 2 (R2) had blood in their urine and management refused to call 9-1-1 until someone could give them a ride.
Continued on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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 6

Control Number 29-AS-20211109115649

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: GRANVIDA SENIOR LIVING AND MEMORY CARE	FACILITY NUMBER: 425802114
	VISIT DATE: 06/16/2023

NARRATIVE

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Staff stated the resident wasn’t transported to the hospital until the following day and was diagnosed with a UTI. Another staff stated Resident 3 (R3) fell in the bathroom and Management didn’t allow 911 to be called immediately and wanted to get something off the computer first. Staff stated 911 was called 30-60 minutes later and the resident ended up having a brain bleed. Staff felt they shouldn’t have worried about paperwork and if they went to the hospital faster maybe more could have been done for them. Based on interviews, multiple staff confirmed multiple occasions where medical attention was delayed at the direction of facility management. Therefore the allegation is deemed Substantiated at this time.

On the allegation: Facility does not have adequate supplies for resident(s). It was alleged Resident 1 (R1) had the wrong size diapers and got a rash because supplies were not reordered timely and staff had to borrow a smaller size from other residents. Staff interviewed stated NOC and weekend shifts are always short on supplies. Staff interviewed revealed the lack of supplies comes up in daily manager meetings. Staff in Creekside didn’t have supplies, often and the staff in charge of ordering are lazy and forget. Staff stated sometimes they are told to go to CVS and buy supplies and it’s a big problem. Managers are in charge of ordering and staff were told at first that the families are in charge of the supplies then the family would show us that they are paying the facility for supplies. Managers then constantly told us they’re on their way but they never came. Staff stated sometimes there are supplies in the basement that are supposed to be put in the residents’ rooms weekly but only managers have the key. One staff stated they have gone to the facility at nighttime when staff needed them to come in to get supplies in the basement because they had a key. Staff stated managers left before 5pm and lived in LA and they didn’t have access to supplies and were told to “borrow” from others. Based on the information obtained the allegation is Substantiated at this time. A citation was already issued for this deficiency on complaint 29-AS-20210722151634, therefore a technical violation was issued.

On the allegation: Facility did not meet Resident's/Residents' care needs. It was alleged that R1 developed a rash due to wearing large briefs when they should be wearing XL briefs. Staff interviews revealed R1 is often left for 3 or more hours in their wet diaper and NOC only changes briefs twice, once at 9:30pm and again at 5:30am. Staff interviews revealed on 10/8/21, multiple residents were found very wet. Staff interviews revealed they believed the facility was short staffed, and there was only one NOC staff to cover all 30 residents, so many needs were not met. Staff interviews revealed there were many call outs and staff were not always able to check on residents, and supplies were limited so resident were left soiled.
Continued on 9099-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 29-AS-20211109115649

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: GRANVIDA SENIOR LIVING AND MEMORY CARE	FACILITY NUMBER: 425802114
	VISIT DATE: 06/16/2023

NARRATIVE

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LPA reviewed documents for R1, but was unable to confirm whether they had a rash as a result of improper incontinence care or wearing briefs that were the wrong size. LPA interviewed residents, who stated staffing was a big problem in 2021. Staff would not respond to call buttons timely and it would take over 20 minutes for staff to come. Resident 4 (R4) reported that one night they laid in bed soiled for over 3 hours waiting for someone to come change them. Finally they decided to get up, walked over to their wheel chair, wheeled downstairs and knocked on memory care to find a staff to help. Based on the information obtained the allegation is deemed Substantiated at this time.

On the allegation: Facility did not report incident of serious illness/injury. It was alleged that Resident 5 (R5) fell and was reporting things going missing and being stolen and the facility didn’t report it. Interviews revealed, there were multiple instances that R4 made allegations against staff for stealing and the facility never reported it or took action. Staff interviewed stated the facility “hardly ever” reports things to licensing or the family members. Resident interviews revealed Resident 4 (R4) had gone to the hospital in 2021. LPA reviewed Incident Reports and could not find any for R4. Based on information obtained the allegation is deemed Substantiated at this time. A Technical Violation will be issued today in lieu of a citation since the facility was cited for not reporting in a case management visit on 2/7/23.

Exit interview conducted, copy of report, appeal rights were printed and emailed.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 6

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
11/09/2021 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20211109115649

FACILITY NAME:	GRANVIDA SENIOR LIVING AND MEMORY CARE		FACILITY NUMBER:	425802114
ADMINISTRATOR:	KAWANA ANTHONY		FACILITY TYPE:	740
ADDRESS:	5464 CARPINTERIA AVE		TELEPHONE:	(805) 566-0017
CITY:	CARPINTERIA	STATE: CA	ZIP CODE:	93013
CAPACITY:	83	CENSUS: 41	DATE:	06/16/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Eric Terrell, Executive Director		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

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Medication(s) not given as prescribed.
Facility is over-charging Residents for additional items.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted an unannounced subsequent complaint visit to issue final findings on the allegations above. LPA Kontilis conducted the 10 day visit, requested relevant documents, interviewed reporting party on 11/9/21. LPA Olson interviewed previous staff who worked at the facility during the time of this complaint on 5/9/2023 and 5/12/23, and Resdients on 6/16/23. LPA met with Executive Director and explained the purpose of the visit.

On the allegation: Medication(s) not given as prescribed. It was alleged that the electronic QMAR the facility uses didn’t match actual doctors orders. Interviews revealed a staff found an Antibiotic bottle for an unnamed resident on 11/7/21, it was full and not on the QMAR. It was also alleged Resident 6 (R6) is not in the QMAR, yet MedTech’s had been giving them vitamins and not signing the QMAR. LPA interviewed multiple staff who stated they could not access files on the QMAR, while one staff interviewed stated they never had issues. Staff stated there were internet issues at the facility, that affected the QMAR system. Staff stated management told staff to “deliver meds by heart”. Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 29-AS-20211109115649

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: GRANVIDA SENIOR LIVING AND MEMORY CARE	FACILITY NUMBER: 425802114
	VISIT DATE: 06/16/2023

NARRATIVE

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Some staff would refuse to give medications unless there were printed records. LPA reviewed facility QMAR records that indicated all medications were given as prescribed. LPA also reviewed doctors orders and all medications were listed on the QMAR. Based on the information obtained, there is insufficient evidence to prove the allegation occurred. Therefore it is Unsubstantiated at this time.

On the allegation: Facility is over-charging Residents for additional items. It was alleged that residents are not receiving showers and paying for more showers then they are receiving. LPA interviewed multiple staff, one staff stated that there was a resident who was paying for 4 showers a week, but only got one due to staffing. Another staff stated residents were paying for 3 course meals and fine dining, but would get sandwiches and complain. Staff also stated that some residents were being charged for haircuts and beauty services like getting their hair curled and nails done twice a week but it was happening every 10 days. LPA interviewed salon staff, Facility Staff, and Residents, who confirmed the residents do not get billed directly from the salon for services. One resident stated they remember some residents saying bill me through the facility but does not remember anyone complaining for being billed for something they didn't receive. LPA interviewed residents about additional services offered by the facility. Residents stated they don't remember being charged for any meal service additions. LPA interviewed Culinary Services Director who has worked at the facility for 3 years and does not remember any special meal plans or services. LPA reviewed Resident Admission Agreements and did not see any options for add on services like dining or beauty services. Based on the information obtained the allegation is deemed Unsubstantiated at this time.

Exit interview conducted, copy of report emailed and printed.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 29-AS-20211109115649

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: GRANVIDA SENIOR LIVING AND MEMORY CARE	FACILITY NUMBER: 425802114
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/16/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/16/2023 Section Cited CCR 87465(g)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis. This requirment was not met as evidenced by:	1 2 3 4 5 6 7	Administrator provided training documenation showing recent staff training covering Incidental Medical Care. The POC was cleared during the visit.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply with the above cited section when the facility did not immediately telephone 911 when residents had an injury or other imminet health threat, which posed an immediatel health and safety risk for residents in care.	8 9 10 11 12 13 14
Type A 06/16/2023 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator provided training documentation showing recent staff training covering Incidental Medical Care. The POC was cleared during the visit.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply with the above cited section when the facility did not have enough staff to meet residents needs leaving them wet for an extended period of time, which posed an immediately health and safety risk for residents in care.	8 9 10 11 12 13 14

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 Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

Page: 6 of 6