425802116-1-24-2024-29-AS-KBUY-D2WRUL-20240229122008

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802116
Report Date: 01/24/2024
Date Signed: 01/24/2024 04:23:16 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
01/17/2024 and conducted by Evaluator Kristin Kontilis

COMPLAINT CONTROL NUMBER: 29-AS-20240117104513

FACILITY NAME:	PACIFICA SENIOR LIVING SANTA BARBARA		FACILITY NUMBER:	425802116
ADMINISTRATOR:	KAREN DACOME		FACILITY TYPE:	740
ADDRESS:	325 W ISLAY ST		TELEPHONE:	(805) 898-2650
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93101
CAPACITY:	36	CENSUS: 14	DATE:	01/24/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Anais Ochoa, Medication Technician		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Due to a lack of staffing, staff are not answering the facility phone.
Staff did not notify authorized representative of incident with resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced subsequent visit to address the above-stated allegations. LPA met with Anais Ochoa, Medication Technician and explained the purpose of the visit. At the time of arrival, there were fourteen residents in care with two staff on duty.
On the allegation, due to lack of staffing, staff are not answering the facility telephone: Reporting Party (RP) stated RP has placed numerous unanswered calls to the facility’s main line and has not been able to leave a message or speak with facility representatives. On 8/23/2023 one call was placed to the facility unanswered. On 8/24/2023, four calls were made to the facility. One call was answered and RP had a conversation with a facility representative. However, after the conversation, RP called back two more times, but the calls were not answered and no voicemail option was available. On 8/25/2023, RP stated two unanswered calls were placed to the facility. Also, on 8/25/2023, RP stated R1’s Physician was trying to fax a prescription to the facility, but the Physician stated the facility's fax machine was not properly functioning. RP stated the calls to the facility and the fax from R1’s Physician were a dire medical concern regarding R1.
Please continue to 9099-C, Pg 2.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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 3

Control Number 29-AS-20240117104513

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: PACIFICA SENIOR LIVING SANTA BARBARA	FACILITY NUMBER: 425802116
	VISIT DATE: 01/24/2024

NARRATIVE

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During today’s visit, interviews conducted revealed that staff are sometimes unable to answer the phone because they are assisting residents with brief changes, showers, medication distribution, and other basic services. Staff 1 (S1) stated when the calls go to voicemail, the staff (caregivers, medication technicians, etc) on duty do not have access to retrieve the voicemail messages. S1 further stated when S1 takes a call and cannot provide information, the caller’s name and phone number are taken in a message book then S1 gives it to a “corporate person” when they come to the facility.
During today’s visit, LPA observed the Business Office Director and the Regional Director of Operations were not available at the facility. Staff stated the Business Office Director was at the facility for approximately three hours on Monday, 1/22/2024. Staff further stated the Regional Director of Operations was at the facility for approximately one hour one day last week, possibly Tuesday, 1/16/2024 or Wednesday, 1/17/2024.
Based on interviews conducted, records reviewed, and observations made, the allegation that due to lack of staffing, the facility staff are not answering the facility telephone is Substantiated at this time.

On the allegation, staff did not notify authorized representative of an incident with a resident, Reporting Party (RP) stated RP learned that Resident 1 (R1) was taken to the hospital emergency room on 12/4/2023 when RP received an invoice from the medical emergency agency about three weeks after the emergency transport. During today’s visit, LPA obtained medical discharge papers and care notes indicating R1 was sent to the hospital via a call to 9-1-1. At approximately 2:34 pm, Staff 2 (S2) stated on 12/4/2023, R1 was sent to the hospital emergency room the evening of 12/4/2023. S2 further stated R1 returned from the hospital emergency room that same evening. LPA reviewed LIC624 Serious Illness/Serious Injury Reports submitted by the facility to Community Care Licensing Division (CCLD) and determined that CCLD did not receive LIC624, Serious Illness/Injury Report notifying CCLD of R1’s hospital visit. At the time of the visit, no record of an incident report was available reporting R1’s emergency room visit to R1’s responsible parties or to CCLD. Based on interviews conducted and records reviewed, the allegation that facility staff did not notify an authorized representative of an incident with a resident is Substantiated at this time.

The following deficiencies were observed (see LIC 9099-D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in 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 Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20240117104513

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: PACIFICA SENIOR LIVING SANTA BARBARA	FACILITY NUMBER: 425802116
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/24/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/25/2024 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	Type A 87411(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs…. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to provide a written plan to CCLD as to how the facility will be diligent in answering telephone calls and responding to responsible parties through telephone communication. Written plan will be submitted to LPA via email no later than 4:00 pm on 1/25/2024.
	8 9 10 11 12 13 14	Based on interviews, record review, and observation, the licensee did not comply in the section cited above as facility staff were unable to answer telephone calls from R1's responsible party on 8/23/2023, 8/24/2023, and 8/25/2023 which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
Type A 01/25/2024 Section Cited CCR 87211(a)(d)	1 2 3 4 5 6 7	87211(a)(1) Each licensee shall furnish to the licensing agency such reports as the Department may require,... (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified...	1 2 3 4 5 6 7	Licensee agrees to provide a written plan to CCLD as to how the facility will be diligent in reporting incidents of serious illness/serious innury to responsible parties and CCLD. Written plan will be submitted to LPA via email no later than 4:00 pm on 1/25/2024.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on record review, observation, and interviews conducted, the licensee did not comply in the section cited above as the facility staff did not notify R1's responsible party of a hospital visit; nor did the facility notify CCLD of the hospital visit.	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: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC9099 (FAS) - (06/04)

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