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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425850025
Report Date: 10/28/2022
Date Signed: 10/28/2022 06:06:07 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
08/26/2022 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20220826113002
FACILITY NAME:SANTA MARIA TERRACEFACILITY NUMBER:
425850025
ADMINISTRATOR:ENRIQUEZ, SANJUANAFACILITY TYPE:
740
ADDRESS:1405 E MAIN STTELEPHONE:
(805) 925-8713
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:140CENSUS: 102DATE:
10/28/2022
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Joanna Enriquez, AdministratorTIME COMPLETED:
06:10 PM
ALLEGATION(S):
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Facility staff are making medical decisions for residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Olson conducted an unannounced follow up complaint visit to issue final findings. LPA requested documents and interviewed staff and residents on 8/31/2022 and Wellness Director on 09/14/2022.

On the allegation: Facility staff are making medical decisions for residents in care. It was alleged that Resident 1 (R1) refused to go to the hospital on 08/25/2022 after a fall, but the facility made the decision that R1 needed to go to the hospital and had the paramedics transport R1 against R1’s wishes. Interview with Wellness Director revealed that R1 hit their head and had a bump on their forehead. Wellness Director stated the facility had a policy that when a resident hits their head they must go out via ambulance and see a doctor regardless of their wishes to be seen. Staff interviews revealed that R1 never wants to go to the hospital and has a general mistrust for doctors.
Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
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 5
Control Number 29-AS-20220826113002
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: 10/28/2022
NARRATIVE
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Emergency Service Personnel interviews revealed that when a resident refuses they usually perform a cognition test and if the patient is cognitive and refuses to go to the Hospital, they provide the resident with a release form for liability and it is against patient’s rights to force them to leave. Emergency Personnel stated the Wellness Director made emergency personnel take R1 to the hospital even though they didn’t feel R1 had to go and R1 refused. LPA informed Wellness Director that the facility cannot force the resident to go to the hospital. Wellness Director stated the staff are not trained and unable to monitor the resident for a change of condition and they cannot put that kind of pressure on the staff in case the resident has a brain bleed and passes out or passes away later. LPA informed Wellness Director that the facility should seek medical attention by calling 9-1-1 and have the resident assessed by Emergency Medical Personnel. Based on the assessment done by Emergency Medical Personnel and the resident and/or Power of Attorney’s (POA) decision, the resident may refuse to be transported. LPA explained usually the Emergency Medical Personnel will have the resident sign a waiver that explains refusing medical services. LPA explained residents have the right to refuse medical care, the same way they have the right to refuse other care. Based on interviews this allegation is deemed 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 809-D)

Exit interview conducted. Report and Appeal Rights issued via email.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20220826113002
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/28/2022
Section Cited
CCR
87468.1(a)(16)
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87468.1(a)(16) Personal Rights. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To receive or reject medical care or other services.
This requirement was not met as evidcned by:
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The administrator understands their policy of transporting residents to the hospital even when the resident refused must be rescinded. The administrator agreed to rescind the policy immediately and will train all staff on resident’s rights and submit training to CCL by 11/04/2022
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Based on interviews, the licensee did not meet the section cited above as resident was not given the right to reject medical care, which poses a potential health, safety, and personal rights risk to residents in care.
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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.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
08/26/2022 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20220826113002

FACILITY NAME:SANTA MARIA TERRACEFACILITY NUMBER:
425850025
ADMINISTRATOR:ENRIQUEZ, SANJUANAFACILITY TYPE:
740
ADDRESS:1405 E MAIN STTELEPHONE:
(805) 925-8713
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:140CENSUS: 102DATE:
10/28/2022
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Joanna Enriquez, AdministratorTIME COMPLETED:
06:10 PM
ALLEGATION(S):
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3
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5
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9
Facility staff made false statements
Facility did not provide emergency information timely to emergency medical personnel
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Olson conducted an unannounced follow up complaint visit to issue final findings. LPA requested documents and interviewed staff and residents on 8/31/2022 and Wellness Director on 09/14/2022.

On the allegation: Facility staff made false statements. It was alleged that the Wellness Director told Emergency Medical Personnel that R1’s POA agreed R1 should be taken to the hospital, when R1 only has a Financial POA. According to Emergency Medical Personnel, the POA stated the facility did not ask for consent for R1 to go to the hospital, but instead told them R1 was going to the hospital. LPA interviewed staff which revealed that R1’s financial POA is called often to help convince R1 to go to the hospital after an illness or incident. Interviews revealed most staff were not aware that this POA is only for financial matters and assumed they could make medical decisions for R1. LPA interviewed R1’s POA who could not provide information about this incident.
Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
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 5
Control Number 29-AS-20220826113002
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: 10/28/2022
NARRATIVE
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 There is insufficient evidence to substantiate this allegation, therefore the allegation is deemed unsubstantiated at this time. However, LPA recommends the facility ensure staff are aware of the powers a resident’s POA has to mitigate potential issues, and advises the Wellness Director to relate accurate information to Emergency Medical Personnel.

On the allegation: Facility did not provide emergency information timely to emergency medical personnel. It was alleged that the facility takes a long time provide resident information to Emergency Personnel. Interviews revealed that after MedTech’s call 9-1-1, they must go to the med room, find the residents emergency binder, make a copy of the Emergency contact and Physicians report then look up their most recent Medication list and print it. Most staff stated this process is lengthy and they have suggested to management many times to make it more streamlined and timely. Interviews with Wellness Coordinator and Wellness Director stated they don’t have the med list preprinted because it changes often and after some practice the MedTech’s should be able to gather the documents in 5 minutes or less. One staff interview revealed that sometimes the binders are unorganized, in the wrong place and they are unable to provide Emergency Personnel with resident records. The staff was unable to provide specific details about when they were unable to provide medical records to emergency responders. LPA observed the resident record room was cluttered with papers and observed resident binders not in their designated spots. Based on observation and interviews, there was insufficient evidence to prove information was not provided timely to emergency medical personnel, therefore the allegation is deemed unsubstantiated at this time. However, LPA recommends the facility streamline their process for gathering emergency information for first responders, and recommends the record room be more organized.

Exit interview conducted, copy of the report emailed to Administrator.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5