425802116-6-11-2024-29-AS-KBUY-D6JNQP-20240624104017

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802116
Report Date: 06/11/2024
Date Signed: 06/11/2024 04:15:35 PM

Unsubstantiated

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
06/04/2024 and conducted by Evaluator Melisa Rankin

COMPLAINT CONTROL NUMBER: 29-AS-20240604085405

FACILITY NAME:	PACIFICA SENIOR LIVING SANTA BARBARA		FACILITY NUMBER:	425802116
ADMINISTRATOR:	MARIA ROSSI		FACILITY TYPE:	740
ADDRESS:	325 W ISLAY ST		TELEPHONE:	(805) 880-4700
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93101
CAPACITY:	36	CENSUS: 14	DATE:	06/11/2024
		UNANNOUNCED	TIME BEGAN:	12:19 PM
MET WITH:	Cynthia Garcia, Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff mismanaging residents medication.
Facility toilet is in disrepair.
Facility is dirty.
Staff engaged in a verbal altercation in presence of residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rankin conducted an initial complaint visit to deliver final findings for the above allegation. During today’s visit, LPA Rankin met with Cynthia Garcia, administrator, and Elizabeth Hernandez, Designee, explained the reason for the visit. LPA toured the facility, reviewed relevant documents, and interviewed administrator, staff, and residents.
On the allegation: Staff mismanaging residents medication. It was alleged that a med tech was signing off that they provided medications without having provided them. LPA interviewed administrator about the allegation. Administrator stated the Memory Care Director brought up the issue and they had a meeting with all med techs to discuss it.

Continued on 9099-C

Unsubstantiated

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)

Page: 1 of 3

Control Number 29-AS-20240604085405

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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Med techs indicated they were marking medications as refused when the medications had been discontinued, but still showed in the e-MAR. Administrator clarified the procedure with med techs so they no longer document refusals when medications were not refused. Administrator also stated they called the doctor to confirm the medication was discontinued, which it was. Based on the information obtained the allegation is deemed Unsubstantiated at this time.

On the allegation: Facility toilet is in disrepair. It was alleged that a toilet was clogged and backed up. Administrator stated staff use the plunger to try to fix the toilet if it is clogged, or they call a plumber. Administrator stated on 5/1/2024, a plumber was at the facility. On 6/4/2024, the plumber was scheduled to come out but did not show up. On 6/5/2024, the plumber snaked the building and did a camera inspection from the clogged toilet through the facility and extended out 17 feet into the front yard toward the street. The camera showed briefs and other objects that had been flushed. The plumber recommended a hydrojet service and this was performed on 6/7/2024. The plumber recommended to monitor the situation and see if it is resolved, otherwise they can do a camera inspection all the way to the street. Administrator also said when doing rounds they will encourage residents to use the restroom at the that time to ensure they have some level of supervision, even if they do not require hands on assistance. Based on the information obtained the allegation is deemed Unsubstantiated at this time.

On the allegation: Facility is dirty. LPA toured the facility with administrator. LPA did not observe any dirty areas. Administrator stated overnight staff also clean the facility and disinfect frequently touched surfaces. Based on the information obtained the allegation is deemed Unsubstantiated at this time.

On the allegation: Staff engaged in a verbal altercation in presence of residents. It was alleged that two staff argued in front of residents. Administrator stated their new protocol is for staff to update the end of shift report indicating if showers were done for residents. Administrator stated a med tech asked a caregiver about the showers, and the med tech laughed at the caregiver. The med tech asked again, and again the caregiver laughed.
Continued on 9099-C

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)

Page: 2 of 3

Control Number 29-AS-20240604085405

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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The med tech called the administrator to notify them, and the med tech talked about sending the caregiver home. Then another staff stated they did not want the caregiver sent home, and it was noted this staff can have a higher pitched tone of voice. When administrator arrived at the facility, a resident asked if the caregiver was in trouble, because that caregiver is his favorite. Administrator counselled both staff and discussed being respectful, not having disagreements in the common area, and always putting the residents first. Administrator also counselled the other staff on de-escalation techniques and maintaining an appropriate tone. Residents interviewed indicated they liked living at the facility, were treated well by staff, and staff were helpful. Residents stated they have never observed staff argue in front of residents. Based on the information obtained the allegation is deemed Unsubstantiated at this time.

Exit interview, report 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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