425802116-6-11-2024-29-AS-KBUY-D6F5FM-20240620195521

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802116
Report Date: 06/11/2024
Date Signed: 06/11/2024 11:55:29 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
11/04/2022 and conducted by Evaluator Melisa Rankin

COMPLAINT CONTROL NUMBER: 29-AS-20221104125523

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: 14	DATE:	06/11/2024
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Cynthia Garcia, Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff did not provide resident's responsible party with records after requested.
Staff did not allow visitor(s) into the facility in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the facility above to issue final findings. LPA met with Cynthia Garcia, Administrator and explained the purpose of the visit. During the investigation, LPA Kontilis conducted the initial visit on 11/14/22, obtained relevant documents, and interviewed staff; R1’s family member was also interviewed.

On the allegation: Staff did not provide resident's responsible party with records after requested. R1’s family member (F1) stated they requested a copy of R1’s chart in October 2020, and August 3 (year not specified).

Continued on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

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-20221104125523

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: PACIFICA SENIOR LIVING SANTA BARBARA	FACILITY NUMBER: 425802116
	VISIT DATE: 06/11/2024

NARRATIVE

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They requested it again in July 2022 and have tried to reach the facility via phone call, texts and messages but had not received the records. F1 was contacted on 6/7/24 and they indicated they still have not received R1’s records. The facility has had a change in personnel since the original request. The facility was notified during the visit that F1 would still like a copy of R1’s records. Based on the information obtained, the allegation was deemed Substantiated at this time.

On the allegation: Staff did not allow visitor(s) into the facility in a timely manner. F1 stated multiple visitors to R1 experienced long wait times at the facility’s front gate, up to 45 minutes to an hour for staff to answer it. On multiple occasions, CCL staff has also encountered a long wait time at the front gate, including most recently on 6/3/24. On 6/3/24, after at least 10 minutes of waiting and calling various phone numbers, LPA had to use the code facility management had previously provided in order to gain access to the facility. Based on the information obtained, the allegation was deemed Substantiated at this time.

Exit interview, deficiencies cited on 9099-D, report given, appeal rights given.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20221104125523

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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: 06/11/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/18/2024 Section Cited CCR 87468.1(a)(11)	1 2 3 4 5 6 7	Personal Rights. To have their visitors…permitted to visit privately during reasonable hours and without prior notice…This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Manager agreed to submit a written plan to ensure all visitors to the facility will be let in in a timely manner. Submit plan by 6/18/24.
	8 9 10 11 12 13 14	Based on interview and observation, the licensee did not comply with this section when visitors were not let into the facility timely to visit, which posed a potential personal rights risk to residents in care.	8 9 10 11 12 13 14
Type B 06/13/2024 Section Cited CCR 87468.2(a)(19)	1 2 3 4 5 6 7	Personal Rights. To have prompt access to review all...records and to purchase photocopies of all their records. Photocopied records shall be provided within two (2) business days…	1 2 3 4 5 6 7	Manager agreed to provide the records to F1 by 6/13/24.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on interview and record review, the licensee did not comply with this section when F1 was not provided R1’s record, which posed a	8 9 10 11 12 13 14	potential personal rights risk to residents in care.

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: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

LIC9099 (FAS) - (06/04)

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