425802114-2-8-2023-29-AS-KBUY-CNZP3J-20230213095736

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802114
Report Date: 02/08/2023
Date Signed: 02/08/2023 10:53:26 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
04/09/2021 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20210409081333

FACILITY NAME:	GRANVIDA SENIOR LIVING AND MEMORY CARE		FACILITY NUMBER:	425802114
ADMINISTRATOR:	AMY BUCHANAN		FACILITY TYPE:	740
ADDRESS:	5464 CARPINTERIA AVE		TELEPHONE:	(805) 566-0017
CITY:	CARPINTERIA	STATE: CA	ZIP CODE:	93013
CAPACITY:	83	CENSUS: 50	DATE:	02/08/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Ted Burgess, Executive Director and Ashley Nash, Business Office Director, and Lumana Seide, Resident Care Director		TIME COMPLETED:	11:05 AM

ALLEGATION(S):

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Resident's bathing needs are not being met.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Olson and Phillips conducted an unannounced follow up complaint visit to issue final findings. LPA Olson met with Ted Burgess, Executive Director and Ashley Nash, Business Office Director, and Lumana Seide, Resident Care Director and explained the purpose of the visit.

On the allegation: Resident's bathing needs are not being met. It was alleged that Resident 1 (R1) didn’t receive a shower for 2 weeks. LPA Olson reviewed R1’s shower schedule. According to the schedule, R1 was showered on 3/20/21. On 3/27/21, a shower was offered but R1 refused. LPA Olson observed an N/A with a line through 3/28/21 and 3/29/21; 3/30/21 is blank; and there is another NA written under 3/31/21. LPA observed 4/1/21-4/4/21 to be blank and 4/5/21 to have an N/A. LPA observed 4/6/21 to have a C (complete) for shampoo hair, Feet Cleaned, Lotion applied. NA was under fingernails trimmed and shave/tweeze, LPA observed a C under Skin Clear and initials JC. The shower log review revealed Resident 1 didn’t have a shower for 16 days. Shower schedule for Resident 1’s room indicates their shower days are on Tuesday and Saturday. 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: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20210409081333

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: 02/08/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/14/2023 Section Cited CCR 87464(f)(4)	1 2 3 4 5 6 7	87464(f)(4) Basic Services. Basic services shall at a minimum include: Personal assistance and care as needed by the resident...with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications…This requrment was not met	1 2 3 4 5 6 7	Administrator agreed to submit a plan to ensure showers are given as agreed to in admission agreement and a plan for how to make up refused showers. Administrator will submit plan to CCL by 2/14/23.
	8 9 10 11 12 13 14	as evidenced by: Based on record review, the licensee did not comply with the section cited above when the facility did not shower the resident for 16 days, which posed an immediate health, safety, and personal rights risk to residents in care.	8 9 10 11 12 13 14
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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 Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 29-AS-20210409081333

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: 02/08/2023

NARRATIVE

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R1 refused on their Tuesday 3/27/21 shower day but was not offered/given a shower on Saturday 3/31/21 and was not showered until the following Tuesday 4/6/21. On 2/7/23, LPA interviewed R1 about their experience with bathing assistance. R1 stated they have been getting their showers but is scared to shower due to being afraid of the bathroom lay out and the gap between the grab bars being too far away but staff offer to make up showers. On 2/8/23 LPA interviewed Resident Care Director about the bathing schedule and how they ensure residents get their scheduled showers each week, even if they refuse or are out of the facility at their scheduled time. Resident Care Director stated during assessment residents can get bathing once a week to daily depending on their needs and preferences. If resident's refuse their morning shower staff tell the medtech and the next pm staff will attempt again and if they refuse again they will wait until the following shower. Based on the information obtained the allegation: Resident's bathing needs are not being met is Substantiated at this time.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D):

Exit interview conducted, copy of report and appeal rights were 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: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC9099 (FAS) - (06/04)

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