425802116-3-6-2024-29-AS-KBUY-D3TNDV-20240329102259

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802116
Report Date: 03/06/2024
Date Signed: 03/06/2024 12:15:50 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 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
02/20/2024 and conducted by Evaluator Brian Phillips

COMPLAINT CONTROL NUMBER: 29-AS-20240220152049

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: 13	DATE:	03/06/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Cynthia Garcia, Business Office Director and Anais Ochoa, Medication Technician		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not ensure residents receive mail correspondence in a timely manner

INVESTIGATION FINDINGS:

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

On 03/06/2024, Licensing Program Analyst (LPA) Brian Phillips arrived at the facility above to conduct a Subsequent Complaint Investigation Visit and Deliver Final Findings. LPA met with Business Office Director Cynthia Garcia and Medication Technician Anais Ochoa and explained the purpose of the visit.

On the allegation: Staff do not ensure residents receive mail correspondence in a timely manner. It is alleged that from 02/16/2024 through 02/20/2024, postal mail has been unable to be retrieved for Resident #1 (R1). The allegation states that the Responsible Party for R1 has attempted each day to get the mail with either no staff available or Staff not having a key to the mailbox/Staff Office where a mailbox key is kept. It is also alleged that none of the residents have been receiving the mail since 02/16/2024.

On 02/26/2024, LPA requested documents pertaining to the investigation, conducted observations of the pertinent areas of the facility, and interviewed both Residents and Staff members of the facility. Contd 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian Phillips	TELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

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-20240220152049

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PACIFICA SENIOR LIVING SANTA BARBARA	FACILITY NUMBER: 425802116
	VISIT DATE: 03/06/2024

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

LPA observed the mail areas in separate sections of the facility and found the mail to be distributed to residents up to the date of the initial visit by LPA. The facility has a main outdoor mail drop box/mailbox for residents of the facility in the front outdoor area of the facility adjacent to the vehicle entrance gate. Additionally, the facility maintains a separate mail drop box/mailbox attached to the Office of the Business Director of the Facility, which is located directly adjacent to the main front door entrance of the facility. LPA toured the facility and observed all areas where mail for residents is placed, distributed, collected, etc. All mail items for residents observed by LPA were of good quality; there was no observed destroyed or tampered mail. There was no indication of any late/undelivered mail, and all resident mail items/letters were observed to be stored properly. During the LPA's touring of the mailbox areas, policies and procedures on the distribution of mail were observed and mail items had the dates that they were received by the facility labeled on the mail. Both mailboxes that received and stored resident correspondence were locked at the time of LPA observation and needed to be unlocked by Staff member with key. There were no observable deficiencies in the mail correspondence to residents at the facility.

On 02/26/2024, LPA interviewed residents and staff about the timeliness of mail correspondence to residents at the facility. LPA interviewed Staff member #1 (S1), who stated that there are only a limited number of Staff members with keys into the mail boxes on site in the facility, but that there is at least one or two Staff members with a mail key on any shift at the facility, AM or PM. S1 stated to LPA that there are also mailbox keys on the same keychains and the keys used to lock Centrally Stored Medication to be inaccessible to residents. S1 showed LPA the process of retrieving the mail from both mailboxes on site. LPA was shown the main large, locked mailbox/drop box at the entrance of the facility outside of the vehicle entrance gate, at the locked door/electronic gate to enter the facility. The second mailbox is smaller and located right outside the door of the Business Office Director, which holds more sensitive documents and documents from resident visitations/relatives/family members. S1 informed LPA that due to a number of residents in the facility having psychological impairments such as Dementia, there are times when mail is received for these residents that a Power of Attorney (POA) or responsible party for the resident needs to be informed of the mail prior to handing it off to a resident. S1 stated many residents with Alzheimer’s/Dementia or related conditions tend to lose their mail and/or misplace it. S1 stated to LPA that the mail is checked daily by facility management/administrator or by the Med Tech(s) on duty on either an A.M. shift or a P.M. shift. S1 stated that they did ensure residents receive mail correspondence in a timely manner, and that sometimes a third party needs to be involved due to the mental capacity of certain residents (POA/Responsible Party). Continued on 9099-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian Phillips	TELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20240220152049

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PACIFICA SENIOR LIVING SANTA BARBARA	FACILITY NUMBER: 425802116
	VISIT DATE: 03/06/2024

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

On 02/26/2024, LPA interviewed multiple residents who indicated that they received their mail on time, and had no issues with postal mail correspondence at the facility. Some residents interviewed stated that the mail correspondence has improved during their time in the facility, and that they have no current complaints. LPA was provided with pertinent documentation by the facility including a Facility Program of Care, Program Description & Brochure, Admission Agreement, Rules of Discipline, Theft & Loss Policy, Statement of Residents’ Personal Rights, Employee listing report with contact information, and Resident roster. The current Resident Admission Agreement for the facility indicates that each resident will have Personal Rights consistent with California law, including the resident personal right to mail and to receive unopened correspondence in a prompt manner.

In addition to LPA observations, interviews, and record review of the facility on 02/26/2024 for the initial complaint investigation visit, LPA interviewed the Responsible Party for R1 on 02/26/2024. LPA asked the Responsible Party for R1 about any suspected Financial Abuse of R1 relating to the Financial Documents for R1 sent to the facility mailing address including a bank card for R1 which were never received. LPA asked RP if they checked the status of R1’s account to make sure any financial information had not been stolen/misused and RP stated that there were no signs of R1's money being used or any signs of financial abuse. RP is the Power of Attorney (POA) for R1 and recently changed the address of the resident from the facility to a P.O. Box so RP is sure the mail will be received. RP stated that the facility has never admitted to receiving any of the mail for R1, and all Staff members interviewed by LPA on 02/26/2024 corroborated this statement. No Staff member admitted to receiving any postal mail for R1 that was described by RP.

Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted, a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian Phillips	TELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3