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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425850204
Report Date: 05/16/2025
Date Signed: 05/16/2025 01:13:00 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
09/27/2024 and conducted by Evaluator Kristin Kontilis
COMPLAINT CONTROL NUMBER: 29-AS-20240927093414
FACILITY NAME:MISSION VILLAFACILITY NUMBER:
425850204
ADMINISTRATOR:EMILY A. GERRFACILITY TYPE:
740
ADDRESS:321 W MISSION STREETTELEPHONE:
(805) 898-2709
CITY:SANTA BARBARASTATE: CAZIP CODE:
93101
CAPACITY:15CENSUS: 13DATE:
05/16/2025
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Emily Gerr, AdministratorTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Staff are not assisting residents with personal care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kontilis conducted a subsequent complaint visit to issue final findings on this investigation. LPA met with Emily Gerr, Administrator and explained the purpose of the visit. During the investigation, LPA conducted an initial visit on 9/30/2024 from 1:00 pm to 2:30 pm, where LPA conducted interviews and obtained relevant documents. LPA conducted additional interviews on 9/30/2024, 10/1/2024, 10/22/2024, 10/23/2024, and 11/19/2024.

On the allegation: Staff are not assisting residents with personal care. It was alleged that residents are not receiving assistance with dental care. One visitor interviewed stated plaque on the bottom teeth of residents was visible and some residents stated their teeth were not being brushed.

Please continue to 9099-C, Pg 2.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
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 3
Control Number 29-AS-20240927093414
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: MISSION VILLA
FACILITY NUMBER: 425850204
VISIT DATE: 05/16/2025
NARRATIVE
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Care notes provided by the Administrator showed one resident refusing all oral hygiene, and after discussing refusals with the family, a care meeting was held to explore strategies. The notes state the resident will be encouraged to engage in teeth brushing, but their right to refuse will be respected. Oral hygiene will be offered at alternate times when a refusal occurs—adapting to the resident’s preferences and comfort. No other care notes for September 2024 indicate other residents refused teeth brushing.
Staff interviewed stated some residents refuse teeth brushing. Staff indicated they do not keep a written log of residents refusing teeth brushing but make additional attempts. When staff were asked about the morning routine and how they care for residents in the morning, some staff mentioned brushing their hair and washing their face, but did not mention teeth brushing. When prompted to discuss teeth brushing, staff stated if the refusal for teeth brushing is consistent, they will notify the families but would not necessarily notify them if they refuse for an hour and then they are able to brush the teeth at another time. One staff stated a resident’s teeth were brushed twice a day, and another indicated some residents have no issues with getting their teeth brushed.

One resident interviewed stated “They have not been brushing my teeth.” Resident’s responsible party confirmed the resident has said that they are not getting their teeth brushed. Another resident stated their teeth are brushed once per week. One resident interviewed stated they had not brushed their teeth since last week.

Another responsible party stated their main issue regrading personal care was teeth brushing and it had been an issue for quite some time. The responsible party stated they asked families/visitors of other residents, who also confirmed other residents were not getting their teeth brushed.

One responsible party stated if they notice the teeth are not being brushed, they say something to the staff; and the care had improved after bringing up concerns. Responsible party stated staff indicated it was difficult because the resident did not know to spit out the toothpaste due to their dementia. Responsible party stated the breath was really bad, and they bought toothpaste that was non-toxic. Based on the information obtained, the allegation is deemed Substantiated at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D):

Exit interview conducted. Copy of report and Appeal Rights issued at the time of the visit.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20240927093414
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: MISSION VILLA
FACILITY NUMBER: 425850204
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2025
Section Cited
CCR
87468.2(a)(2)
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87468.2(a)(4)…Residents…shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
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Administrator agrees to submit a written plan that discusses how residents’ oral hygiene needs and care needs will be met.
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This requirement was not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above when they did not ensure residents received proper oral hygiene assistance, which posed a potential risk to residents in care. health and personal rights.
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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.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025
LIC9099 (FAS) - (06/04)
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