425850025-12-2-2021-29-AS-KBUY-C9GPYR-20211207104418

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850025
Report Date: 12/02/2021
Date Signed: 12/02/2021 06:42:24 PM

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
03/31/2020 and conducted by Evaluator Arien Diaz

COMPLAINT CONTROL NUMBER: 29-AS-20200331133055

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: 83	DATE:	12/02/2021
		UNANNOUNCED	TIME BEGAN:	01:31 PM
MET WITH:	Joanne Enriguez		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff spoke inappropriately to resident
Facility staff did not treat resident with respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Diaz conducted a complaint visit to deliver final findings of the complaint investigation conducted by LPA Diaz.

LPA Diaz reviewed facility documents and conducted interviews with staff and residents. LPA interviewed clients on 10/5/2020 and 10/7/2020 between 3:00pm and 5:00pm. LPA interviewed clients on 08/5/2020 between 11:00am and 12:00pm. LPA interviewed staff on 6/11/2020 between 4:00pm and 5:00pm. LPA interviewed staff on 08/6/2020 between 11:28am and 3:30pm. LPA interviewed staff on 09/8/2020 between 2:51pm and 4:00pm. LPA interviewed staff on 11/24/2021 between 3:00pm and 4:00pm. LPA interviewed staff on 12/1/2021 between 3:00pm and 4:00pm. LPA interviewed staff on 12/2/2021 between 1:30pm and 3:30pm. On the allegation: Facility staff speak inappropriately to resident: All staff interviewed stated that they have never heard any verbal abuse or profanity used towards a resident. All staff stated they understand what a mandated is and would report any abuse to their supervisor. 9 out of 9 residents stated that they like living in the facility and the staff are kind.

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: 12/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021

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-20200331133055

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: 12/02/2021

NARRATIVE

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All residents interviewed confirmed that they have never witnessed any staff members speak inappropriately towards the residents. Based on the interviews, the allegation that the facility staff speak inappropriately to resident is deemed unsubstantiated at this time.

On the allegation: facility staff did not treat resident with respect. 6 out 6 staff consistently explained that Resident 1 (R1) was declining in health and was placed on hospice. 6 out of 6 caregivers described R1 as an anxious bedridden resident that became needy towards the end of their stay at the facility. According to the staff, R1 was always reliant on the caregivers and R1 did not want to be left alone. All staff stated that R1 was given full care at the facility. The caregivers made consistent rounds and provided care to R1. All staff stated that R1 was always treated with respect and dignity. The facility Director observed the caregivers to be patient and treat R1 with respect. R1 would constantly press their call button and staff always responded to R1. 9 out of 9 residents stated that they like living in the facility and are treated with respect. Based on the interviews, the allegation: facility staff did not treat resident with respect 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: 12/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021

LIC9099 (FAS) - (06/04)

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