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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425850025
Report Date: 10/28/2022
Date Signed: 10/28/2022 06:00:12 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
10/04/2022 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20221004131630
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):
1
2
3
4
5
6
7
8
9
Facility did not meet resident's care needs
Facility did not follow refund policy
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Olson conducted an unannounced follow up complaint visit to issue final findings. LPA requested documents and interviewed staff on 10/10/2022 and 10/28/2022. LPA interviewed Reporting Party on 10/17/2022. LPA met with Administator Joanna Enriquez.

On the allegation: Facility did not meet resident's care needs. It was alleged that the facility did not shower Resident 1 (R1) twice a week or provide proper toileting assistance. Staff interviews revealed that R1 was difficult to bathe and would often refuse to shower. Staff stated that R1 did not have a shower chair at first and staff had to give R1 a sponge bath until the family provided one. R1 moved into the facility on 5/6/22, and LPA reviewed R1’s care notes from 5/6/22 through 7/15/22. Records indicate R1 did not have a shower after moving in 5/6/22 until 5/21/22, and the next shower after that was on 6/11/22. There were no documented refusals between 5/6/22 and 5/28/22. Records show that R1 did not receive two showers per week at the facility.
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-20221004131630
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
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
 LPA reviewed toileting assistance records from 5/6/22 through 6/30/22 which indicated missing entries on 6/1, 6/7, 6/9, 6/16, 6/18, and 6/23. Interviews revealed each shift (morning, afternoon and night) must check off each task once complete. The dates listed above were missing the NOC shift entry which indicated R1’s toileting needs were not met during that shift. Based on record review and interviews, this allegation is deemed Substantiated at this time.

On the allegation: Facility did not follow refund policy. Reporting Party stated Resident 1 moved in on 5/6/22 and moved out on 7/19/22 and therefore is entitled to a 40% Community Fee Refund. LPA reviewed R1’s admission agreement page 6 which states: “4.1. Community Fee Refund Policy…4.1.4. If the resident leaves the Community for any reason during the third month of residency, the resident is entitled to a refund of 40 percent (40%) of the Community Fee in excess of $500”. LPA interviewed Administrator on 10/10/22 who stated although R1 moved out on 7/19/22 they did not provide a proper 30-day notice until 7/19/22 with a move out date of 8/19/22. However, the admission agreement and health and safety code state that the resident is entitled to a 40% refund if the resident leaves for any reason “during the third month of residency.” R1 left the facility during their third month of residency. Therefore the 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, Deficiencies, Civil Penalty, 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-20221004131630
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
11/04/2022
Section Cited
CCR
87464(d)
1
2
3
4
5
6
7
87464(d) Basic Services. …If a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal ...either directly or through outside resources.
1
2
3
4
5
6
7
Administrator agreed to submit a plan to ensure all residents receive their Basic Services by 11/04/2022
8
9
10
11
12
13
14
This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not comply with the above cited section when R1's needs were not met, which posed a potential health and safety risk to residents in care.
8
9
10
11
12
13
14
Type B
11/04/2022
Section Cited
CCR
87464(f)(6)
1
2
3
4
5
6
7
87507(g)(5)(E)(2)(c) Admission Agreements. A refund of at least 40 percent of the preadmission fee in excess of $500 shall be provided if the resident leaves the facility for any reason during the third month of residency.
1
2
3
4
5
6
7
Administrator agrees to provide a refund to R1. Administrator will provide proof a refund was issued to CCL by 11/04/2022
8
9
10
11
12
13
14
This requirement was not met as evidenced by:
Based on interviews and record review, the licensee did not comply with the above cited section when R1 was not given a 40 percent refund, which posed a potentail health and safety risk to residents in care.
8
9
10
11
12
13
14
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
10/04/2022 and conducted by Evaluator Jeannette Olson
COMPLAINT CONTROL NUMBER: 29-AS-20221004131630

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):
1
2
3
4
5
6
7
8
9
Facility did not follow admissions agreement
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Olson conducted an unannounced follow up complaint visit to issue final findings. LPA requested documents and interviewed staff on 10/10/2022 and 10/28/2022. LPA interviewed Reporting Party on 10/17/2022. LPA met with Administator Joanna Enriquez.

On the allegation: Facility did not follow admissions agreement. It was alleged that R1’s bed was not made daily as stated in the admission agreement and the facility did not transport R1 to appointments. LPA reviewed R1’s care notes from 5/6/22-6/30/22 which indicate that R1’s bed was made and the trash was taken out daily. Interview with reporting party on 10/17/22 revealed that there were multiple times the facility was aware of R1’s appointments but then was not able to take R1 at the last minute, and did not arrange transportation for R1 to the appointment. LPA reviewed R1’s Admission Agreement which states on page 1: “Basic Services, The community shall provide the following basic services to you as outline in your monthly rate in Schedule A….
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-20221004131630
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
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
1.1. Basic Services included in the Net Monthly Fee…1.1.11. Transportation, as scheduled, to local shopping, banks, grocery stores and medical appointments in Santa Maria and the surrounding vicinity.” LPA interviews with Administrator regarding transportation indicated the facility will arrange transportation to appointments on Tuesday and Thursday and if the driver was unavailable, the activities director can transport residents. Administrator stated that if the facility is unable to transport a resident, they may contact the family to see if they can transport the resident. The facility does not have a transportation schedule or log showing rides given. Based on the investigation, there is insufficient evidence to prove this allegation, therefore it is deemed Unsubstantiated at this time. LPA advised the facility that the facility is required to arrange transportation to medical appointments for residents, and recommended updating their transportation plan to ensure they are compliant with regulations.

Exit interview conducted, copy of report emailed to the 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