<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425802471
Report Date: 11/16/2022
Date Signed: 11/16/2022 04:51:49 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
11/09/2022 and conducted by Evaluator Kristin Kontilis
COMPLAINT CONTROL NUMBER: 29-AS-20221109102954
FACILITY NAME:PATHPOINT - E MICHELTORENA STFACILITY NUMBER:
425802471
ADMINISTRATOR:HANNAH MORRISFACILITY TYPE:
735
ADDRESS:107 E MICHELTORENA STTELEPHONE:
(805) 363-0773
CITY:SANTA BARBARASTATE: CAZIP CODE:
93101
CAPACITY:12CENSUS: 11DATE:
11/16/2022
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Madison Niessen, Program ManagerTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff illegally evicted resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced initial complaint visit for the above allegation(s). The LPA met with Madison Niessen, Program Manager and explained the reason for the visit.
Entrance interview conducted.
During today's visit, the LPA conducted a physical tour of the facility. LPA requested and obtained documents pertaining to the investigation and conducted an interview with Madison Niessen, Program Administrator.
On the allegation that facility staff illegally evicted resident, Resident 1 (R1) was issued directly by hand-delivery a 30-day eviction notice on 7/29/2022. R1 signed the eviction notice of 7/29/2022. On 8/10/2022, Program Administrator rescinded the eviction notice and notified R1’s case manager and CCLD via email.
On 10/6/2022, R1 was sent to the hospital due to a fall and was admitted. On 10/13/2022, while R1 remained in the hospital, Program Administrator sent a second 30-day eviction notice to R1’s case manager and a case manager supervisor of Assertive Community Treatment (ACT) requesting it be “relayed” to R1.
Please continue to 9099-C, Pg 2.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
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 4
Control Number 29-AS-20221109102954
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: PATHPOINT - E MICHELTORENA ST
FACILITY NUMBER: 425802471
VISIT DATE: 11/16/2022
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
The second eviction notice was not directly given to R1, nor does the facility have proof of signature by R1 that R1 received the second eviction notice. Additionally, CCL was not notified of the second eviction. Based on interviews and record review, the allegation that facility staff illegally evicted resident is Substantiated at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D).

Exit interview conducted. Report and Appeal Rights issued via email.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20221109102954
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: PATHPOINT - E MICHELTORENA ST
FACILITY NUMBER: 425802471
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/18/2022
Section Cited
CCR
80068.5
1
2
3
4
5
6
7
80068.5 Eviction Procedures: Except for children's residential facilities, the licensee may, upon 30 days written notice to the client, evict the client only for one or more of the following reasons…

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee agrees to submit 30-day eviction letters directly to clients and CCL. Licensee agrees to submit written statement to CCL acknowledging in the future 30-day eviction letters will be submitted to CCL.
8
9
10
11
12
13
14
Based on interview and record review, facility did not properly notify R1 of a 30-day eviction when Program Manager sent a second eviction notice to R1’s case manager and case manager supervisor or notified CCL of the second eviction which poses a potential health and safety risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
11/09/2022 and conducted by Evaluator Kristin Kontilis
COMPLAINT CONTROL NUMBER: 29-AS-20221109102954

FACILITY NAME:PATHPOINT - E MICHELTORENA STFACILITY NUMBER:
425802471
ADMINISTRATOR:HANNAH MORRISFACILITY TYPE:
735
ADDRESS:107 E MICHELTORENA STTELEPHONE:
(805) 363-0773
CITY:SANTA BARBARASTATE: CAZIP CODE:
93101
CAPACITY:12CENSUS: 11DATE:
11/16/2022
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Madison Niessen, Program ManagerTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff falsified appraisal of resident needs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced initial complaint visit for the above allegation(s). LPA met with Madison Niessen, Program Manager and explained the reason for the visit.
On the allegation that facility staff falsified appraisal of resident needs, On 7/19/2022, R1 attended a Primary Care appointment with R1’s physician. R1’s Physician’s Report (LIC602) dated 7/19/2022 revealed R1 is non-ambulatory. Based on the Physician’s Report dated 7/19/2022, Program Manager conducted a re-appraisal of resident’s needs based on the Physician’s Report dated 7/19/2022. R1’s Appraisal/Needs and Services Plan (LIC625) was updated by Program Manager to reflect R1’s re-appraisal based on the Physician’s Report (LIC602) dated 7/19/2022. Based on interview and record review, the allegation that facility staff falsified appraisal of resident needs is Unsubstantiated at this time.

Exit interview conducted. No deficiencies noted. Copy of report issued via email.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4