425802116-6-25-2025-29-AS-KBUY-DK2SCV-20250729134610

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802116
Report Date: 06/25/2025
Date Signed: 06/25/2025 02:29:32 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
06/18/2025 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20250618090543

FACILITY NAME:	SANTA BARBARA MEMORY CARE		FACILITY NUMBER:	425802116
ADMINISTRATOR:	LISA GERR		FACILITY TYPE:	740
ADDRESS:	325 W ISLAY ST		TELEPHONE:	(805) 880-4770
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93101
CAPACITY:	36	CENSUS: 15	DATE:	06/25/2025
		UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Adminsitrator, Lisa Gerr		TIME COMPLETED:	02:27 PM

ALLEGATION(S):

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Staff are mismanaging residents medication.

INVESTIGATION FINDINGS:

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At 11:30am on 06/25/25, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the initial investigation to the allegation to this complaint. LPA met with,Adminsitrator, Lisa Gerr, announced who he is and the reason for the visit. LPA conducted interviews, requested and reviewed documentation. Based on documentation and interviews, LPA was able to make a determination a final finding on the allegation to this complaint as follows:
As to the allegation of, "Staff are mismanaging residents medications." It was alleged that, Resident 1 (R1) was hospitalized on 05/01/25 and subsequently did not return as a resident to this facility on that day. The evening of 05/01/25, R1's medications were provided to Witness 1 (W1), R1's responsible party, with the medication Olanzapine 2.5mg missing, according to W1. It was discovered through interview on 06/23/2025, LPA Jeffries interviewed W1 who stated, "the facility Administrator (Lisa Gerr) brought the medications to me (W1), and after looking through the medications, I (W1) observed that some medications were missing, especially...(R1) chemo medication (Olanzapine 2.5mg)."
CONTINUED on LIC9099- C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025

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-20250618090543

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: SANTA BARBARA MEMORY CARE	FACILITY NUMBER: 425802116
	VISIT DATE: 06/25/2025

NARRATIVE

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W1 stated that they contacted Administrator Lisa Gerr who stated that the medication Olanzapine was not delivered to her facility until after R1's discharge on 05/01/25. W1 stated that they have receipt from Federal Drug Company that shows all medications were delivered to the facility on 04/22/25. W1 stated that the missing medication was eventually provided to R1's new facility Administrator on 05/19/2025. On 06/25/25 LPA Jeffries conducted an interview with Administrator Lisa Gerr, who stated, "..on (05/01/2025) R1 returned to the facility after normal business hours requesting all medications for 1 week. Administrator provided all medications from R1's medication storage bin with custody receipt provided and singed. Administrator stated that medication in question was placed in S1 desk drawer and was discovered at unknown later date and was delivered to new facility with custody receipt 05/19/25.On 06/24/25, LPA reviewed documentation from Federal Drug Company, Drug Order Delivery Form, which indicated that a total of 6 medications, including (Olanzapine 2.5mg, Quantity 30) were delivered to this facility on 04/22/25, singed and dated by facility Staff 1 (S1). This delivery form establishes the custody of R1's medications were in the care of this facility starting on 04/22/25. On 05/01/25 all other medications, with the exception of Olanzapine 2.5mg, were provided to W1 by the Administrator, Lisa Gerr, due to R1 permenatly leaving as a resident on the evening of 05/01/25. On 06/25/25, LPA Jeffries received an email from Robert Glock, Administrator of Rt 1's current facility stating that on 05/19/25 Lisa Gerr dropped of R1's personal items that included the Olanzapine 2.5mg medication. Due to the facility having documented custody of the Olanzapine medication on 04/22/25, and on 05/01/25 Administrator, Lisa Gerr provided W1 with R1s medications, excluding the Olanzapine, Based on documentation, and interviews, there is enough evidence to support the allegation of, "Staff are mismanaging residents medications." and is substantiated at this time.

Exit interview, report read, citation issued, appeal rights and report provided.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 29-AS-20250618090543

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: SANTA BARBARA MEMORY CARE	FACILITY NUMBER: 425802116
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/25/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/26/2025 Section Cited CCR 87217(i)	1 2 3 4 5 6 7	87217(i) Upon discharge of a resident, all cash resources, personal property and valuables of that resident which have been entrusted to the licensee shall be surrendered to the resident, or his responsible person. A signed receipt shall be obtained. This requirement was	1 2 3 4 5 6 7	Administrator agreed to write a medication intake policy for facility that has time limits and double oversight by multiple staff for all medication intake. Emailed to LPA Jeffries on or before 06/26/2025.
	8 9 10 11 12 13 14	not met by evidence of Medication Delivery Record date and date specific medication was not provided to R1's representative. Which poses an immanent 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.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025

LIC9099 (FAS) - (06/04)

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