425850025-2-2-2024-29-AS-KBUY-D2UUJZ-20240227143824

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850025
Report Date: 02/02/2024
Date Signed: 02/02/2024 04:32:55 PM

Unsubstantiated

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
12/11/2023 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20231211123120

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: 95	DATE:	02/02/2024
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Vanessa Vazquez, Wellness Coordinator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff made inappropriate comment towards resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted an unannounced subsequent complaint visit to issue final findings on the allegation above. LPA Olson and Miller interviewed Staff and Administrator on 12/15/23 and requested relevant documents. LPA met with Administrator and explained the purpose of the visit.

On the allegation: Staff made inappropriate comment towards resident. It was alleged that Staff stated a resident with dementia was “ pathetic “ because they needed help being assisted back to their room. LPA interviewed the staff who stated they had just called for a care staff to come assist the resident back to their room. They thought they were just talking to a co-worker and said, it’s pathetic that you can’t get back to your room when you have dementia. Staff stated there was no one else in the room at the time and there was no way anyone overheard. Staff also stated they would never say anything like that to a resident or around residents. Staff said they have a family member with dementia, and it is a very sensitive topic for them.

Continued on 9099-A

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20231211123120

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: 02/02/2024

NARRATIVE

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They also said they meant no disrespect and was not calling the resident pathetic. Based on the information obtained the allegation is deemed Unsubstantiated.

LPA issued Technical Assistance to Administrator stressing they review with staff the importance of how they talk to and about residents and confirm all staff are up to date on Residents Personal Rights.

Exit interview conducted, copy of report issued.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC9099 (FAS) - (06/04)

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