425802116-5-31-2023-29-AS-KBUY-CTFVB8-20230705161705

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802116
Report Date: 05/30/2023
Date Signed: 05/31/2023 08:31:34 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
05/23/2023 and conducted by Evaluator Kristin Kontilis

COMPLAINT CONTROL NUMBER: 29-AS-20230523091048

FACILITY NAME:	PACIFICA SENIOR LIVING SANTA BARBARA		FACILITY NUMBER:	425802116
ADMINISTRATOR:	MIRIAM SANTIAGO		FACILITY TYPE:	740
ADDRESS:	325 W ISLAY ST		TELEPHONE:	(805) 898-2650
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93101
CAPACITY:	36	CENSUS: 20	DATE:	05/30/2023
		UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Miriam Santiago, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility did not issue a prospective resident a refund of the deposit paid after deciding not to move in.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced initial complaint visit for the above stated allegation. LPA met with Administrator Miriam Santiago and explained the purpose of the visit.
Entrance Interview Conducted:
On the allegation, Facility did not give a prospective resident a refund of the deposit paid after deciding not to move in: On 3/4/2023, Prospective Resident 1’s (PR1’s) responsible party (RP) met with Administrator Miriam Santiago to discuss the possible placement of PR1 into the facility at which time, RP issued a personal check in the amount of $3,000 as a deposit to hold PR1's apartment. On 3/4/2023, RP was issued a Refundable Community Fee Agreement which states, “The Community Fee will reserve an apartment for a period not to exceed 30 days. After that time, the reservation will be cancelled and the apartment may be made available to another party.”
On 3/8/2023, Administrator Miriam Santiago conducted a preassessment evaluation of PR1 at the private home of PR1 and RP. At that time, RP provided to Administrator documents regarding care and needs for PR1. <Please continue to 9099-C, Pg 2.>

Substantiated

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: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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-20230523091048

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: 05/30/2023

NARRATIVE

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On 3/17/2023, RP informed Administrator Santiago that PR1 would not be moving into the facility. Administrator stated to RP that a refund would be issued for $2,500 and $500 would be withheld to cover the costs of a preassessment conducted by Administrator Santiago which was conducted on 3/8/2023 in PR1 and RP’s private home.
Records reviewed revealed RP attempted contact inquiring about the issuance of the refund with Administrator Santiago on 4/25/2023, 5/7/2023, 5/9/2023, 5/17/2023, 5/21/2023, and 5/22/2023. Administrator Santiago confirmed contacts by RP on 5/9/2023, 5/17/2023, and 5/22/2023.
Records reviewed revealed an email exchange between Administrator Santiago, Sanket Patel, Corporate Associate, Accounting Dept, Pacifica Senior Living, and Tonya Crawford, Accounts Receivable Manager, Pacifica Senior Living discussing RP’s refund. On 5/25/2023, Administrator Santiago confirmed to Pacifica Senior Living corporate representatives that a preassessment was conducted and the refund amount should be $2,500. During today’s visit at approximately 3:16 pm, Administrator Santiago stated she has not received a response from the corporate office regarding RP’s deposit.
Based on the interviews conducted and records reviewed, LPA determined that the Licensee should have issued a refund in the amount of $2,500 on 4/1/2023 based on the information that RP informed Administrator Santiago on 3/17/2023 that PR1 would not be moving into the facility. Moreover, based on the Refundable Community Fee Agreement dated 3/17/2023, the Licensee should have issued the $2,500 refund to RP no later than 5/11/2023—fifteen (15) days after the cancellation of the apartment hold on 4/16/2023. Therefore, the allegation that facility did not give a prospective resident a refund of the deposit paid after deciding not to move in is Substantiated at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC9099-D).

Exit interview conducted. Citation issued. Due to technical difficulties, copy of report and Appeal Rights were issued via email after signatures were obtained.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230523091048

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: 05/30/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/02/2023 Section Cited CCR 87507(g)(5)(E)(2)	1 2 3 4 5 6 7	(g) Admission Agreements. Admission agreements shall specify the following: (5) Refund conditions: (E) Preadmission fees shall be refunded according to the following conditions: … (a) A refund of at least 80 percent of the preadmission fee in excess of $500 shall be provided if the applicant does not enter the facility after a preadmission appraisal is conducted, or the resident leaves the facility for any reason during the first month of residency. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	POC: A refund will be issued to RP no later than POC due date. A copy of the check and the address to where the check will be mailed will be submitted to CCL by the POC due date.
	8 9 10 11 12 13 14	Based on the record review and interviews conducted, the licensee did not comply with the section cited above when PR1’s responsible party did not receive a refund within 15 days after PR1’s responsible party decided not to move PR1 into the facility.	8 9 10 11 12 13 14	POC: Administrator agrees to review the admission policies and Title 22 Regulations and will follow refund policies as required.
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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: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

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