425850025-10-14-2020-29-AS-KBUY-BUFTVQ-20201016150418

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850025
Report Date: 10/13/2020
Date Signed: 10/14/2020 08:44:50 AM

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
07/27/2020 and conducted by Evaluator Arien Diaz

COMPLAINT CONTROL NUMBER: 29-AS-20200727133657

FACILITY NAME:	SANTA MARIA TERRACE		FACILITY NUMBER:	425850025
ADMINISTRATOR:	ENRIQUEZ, SANJUANA		FACILITY TYPE:	740
ADDRESS:	1405 E MAIN ST		TELEPHONE:	(805) 925-8713
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY:	140	CENSUS: 85	DATE:	10/13/2020
		UNANNOUNCED	TIME BEGAN:	03:32 PM
MET WITH:	Administrator Joanna Enriquez		TIME COMPLETED:	04:06 PM

ALLEGATION(S):

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Lack of supervision resulting in resident sustaining multiple falls
Facility staff do not respond to resident's call button in a timely manner
Facility staff do not assist resident with toileting needs in a timely manner
Facility staff did not seek medical attention in a timely manner
Facility staff did not keep resident's room clean
Facility staff do not serve a good quality of food
Facility staff speak inappropriately to resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Diaz conducted a subsequent complaint visit to deliver final findings of the complaint investigation. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, LPA Diaz met on a telephonic video with Administrator Joanna Enriquez.

During a previous visit completed by LPA Diaz, facility was toured, residents were interviewed, staff were interviewed, and pertinent documents were obtained for review. The following was then determined.

Lack of supervision resulting in resident sustaining multiple falls: All staff interviewed stated consistent procedures to ensure residents are frequently observed. Staff members interviewed stated that they check on residents who had a fall every 2 hours for 72 hours. Staff members interviewed also stated there are backup MedTech’s or Caregivers to provide additional support. One staff member stated that Resident 1 (R1) would not use the call button, and fell attempting to move by herself.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Arien Diaz	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2020

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-20200727133657

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 MARIA TERRACE	FACILITY NUMBER: 425850025
	VISIT DATE: 10/13/2020

NARRATIVE

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Three staff members confirmed that R1 was regularly check on. R1 would often urinate in her briefs and then staff would clean her. Observing the facility’s frequent checklist, R1 was regularly checked on and this documented by staff. Based on R1’s care plan and admission agreement, R1 did not have or require a one on one staff. Therefore, based on the interviews, the allegation for lack of supervision resulting in resident sustaining multiple falls is deemed unsubstantiated at this time.

Facility staff do not respond to resident's call button in a timely manner: During the initial complaint visit on 08/05/20, LPA Diaz interviewed both staff and residents regarding this allegation. LPA had Staff 1 (S1) press a resident’s call button to test it, and during this test a different staff member responded to the call in 2 minutes. S1 provided LPA with the facility’s call log, which indicated instances with no responses made, or long response times given by the staff. S1 stated that the call log contains some response errors, and therefore provided the facility’s frequent check list as secondary evidence. The frequent check list indicated R1 was regularly checked on. LPA then interviewed residents with longer response times and determined that 7 of 9 residents stated that the staff responds right away but can take a longer time if other residents are being helped. The other 2 residents stated that staff responds quickly to their call buttons without delay and had not experienced long wait times. Staff members interviewed stated the policy for response time to assist a resident is within 5 min or less. Based on the interviews and observation, the allegation that the facility staff does not respond to resident's call button in a timely manner is deemed unsubstantiated at this time.

Facility staff do not assist resident with toileting needs in a timely manner: LPA Diaz interviewed both staff and residents regarding this allegation. The staff members interviewed stated that all residents are checked on every 2 hours if not more. LPA interviewed 7 incontinent residents that stated staff always provides toileting assistance when needed. 7 of 9 residents stated that the staff responds right away but can take a longer time if other residents are being helped. All residents interviewed stated they like living at the facility and their needs were being met. Based on the interviews, the allegation that facility staff do not assist resident with toileting needs in a timely manner is deemed unsubstantiated at this time.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Arien Diaz	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20200727133657

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 MARIA TERRACE	FACILITY NUMBER: 425850025
	VISIT DATE: 10/13/2020

NARRATIVE

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Facility staff did not seek medical attention in a timely manner: LPA Diaz interviewed both staff and residents regarding this allegation. All residents interviewed stated that the staff would help them if they needed medical assistance. All interviews with staff confirm that caregivers and backup caregivers are readily available to help in a timely manner. Observing the facility’s frequent checklist, R1 was regularly checked on and documented by staff. On 6/16/2020, R1 noted to have low blood sugar. Staff gave R1 juice and rechecked the blood sugar level. After discussing the new readings with R1’s responsible party, the decision was made to send R1 to the hospital. Based on all interviews conducted, no evidence was that the facility staff did not seek medical attention in a timely manner and therefore the allegation is deemed unsubstantiated at this time.

Facility staff did not keep resident's room clean: According to the facility staff, resident rooms are cleaned at least once a week by housekeeping, and the caregivers will clean rooms as needed. The housekeepers clean the floors, restrooms, and wipe down the furniture. The caregivers additionally will clean up spilled drinks or assist with laundry. 9 of 9 residents interviewed stated that the rooms are cleaned once a week and are satisfied with the cleanliness of the rooms. Interviews with both residents and staff confirm that resident rooms are regularly cleaned. Based on the interviews, the allegation that the facility staff did not keep resident's room clean is deemed unsubstantiated at this time.

Facility staff do not serve a good quality of food: During the initial complaint visit on 08/05/20, LPA Diaz observed fresh fruits and vegetables inside the kitchen freezer. LPA also observed in the kitchen a plate of food that appeared to be of substantial size of adequate food quality. S1 revealed that meals are served one floor at a time to ensure that meals are served hot. All staff interviews stated that the meals are served warm or hot. Staff#2 (S2) stated that some residents prefer their food warmer, and therefore some residents warm their food in the microwave. 7 of 9 residents stated that the food is good or satisfactory and served warm. 1 of 9 residents interviewed stated that they additionally heat up their food in the microwave. Based on the interviews and observation, the allegation that the facility staff do not serve a good quality of food: is deemed unsubstantiated at this time.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Arien Diaz	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2020

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20200727133657

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 MARIA TERRACE	FACILITY NUMBER: 425850025
	VISIT DATE: 10/13/2020

NARRATIVE

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Facility staff speak inappropriately to resident: All staff interviewed stated that they have never heard of any verbal abuse or profanity towards a resident. All staff interviewed were familiar with mandated reporter requirements. 9 out of 9 resident interviews confirm they have not witnessed staff speaking inappropriately towards residents. Based on the interviews, the allegation that the facility staff speak inappropriately to resident is deemed unsubstantiated at this time.

Exit interview, report given via email.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Arien Diaz	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2020

LIC9099 (FAS) - (06/04)

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