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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425850241
Report Date: 05/05/2026
Date Signed: 05/05/2026 03:37:12 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
03/09/2026 and conducted by Evaluator Kristin Kontilis
COMPLAINT CONTROL NUMBER: 29-AS-20260309111520
FACILITY NAME:VILLA SANTA BARBARAFACILITY NUMBER:
425850241
ADMINISTRATOR:ROBERT GLOCKFACILITY TYPE:
740
ADDRESS:227 E. ANAPAMU STREETTELEPHONE:
(805) 963-4428
CITY:SANTA BARBARASTATE: CAZIP CODE:
93101
CAPACITY:126CENSUS: 92DATE:
05/05/2026
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Robert Glock, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not properly assist with the self-administration of medications.
Staff do not refill residents’ medication prescription in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced subsequent complaint visit to deliver final findings for the above-stated allegations. During today’s visit, LPA met with Administrator Robert Glock and explained the purpose of the visit. LPA Kontilis conducted the initial visit on 3/11/2025 from approximately 11 am – 6:15 pm at which time LPA conducted interviews and obtained documents pertaining to the investigation.
On the allegation, Staff did not properly assist with the self-administration of medications: It has been alleged that Medication Technicians (Med Techs) administered incorrect medication(s) to residents and substituted medications when a resident’s medications were not available. Additionally, reporting party stated when Resident 1 (R1) had voiced to fellow residents that R1 had to correct Med Techs so as R1 would not be administered incorrect medications, the other residents voiced similar experiences with their medications. Record review revealed on 1/15/2026 at 9:00 pm R1 refused self-administration of Clonazepam 0.5mg tablet. Record review revealed R1 reported to their responsible party via text message on 1/15/2026 at
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: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
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 4
Control Number 29-AS-20260309111520
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: VILLA SANTA BARBARA
FACILITY NUMBER: 425850241
VISIT DATE: 05/05/2026
NARRATIVE
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9:13 pm they had just received their medications, but it was the incorrect amount, noting it was 0.25 mg instead of 0.5 mg. R1 indicates their medications were updated after the hospital visit, but this information could not be confirmed. Additionally, text messages revealed on 2/10/2026 R1 was not provided their morning dose of Effexor as of 8:00 am. However, the MAR shows the medication was provided at 7:00 am. Interviews conducted revealed on separate occasions, staff attempted to deliver R1’s Gabapentin 100mg medication for self-administration, but R1 refused the medication because the staff was providing the medication too early. However, this could not be confirmed by documentation.
On 4/3/2026, the facility provided incident reports indicating medication errors for three residents that were discovered after a medication audit for all residents in the facility who rely on facility personnel to manage their medications. Resident 2 (R2) had multiple medication discrepancies after returning from a Skilled Nursing Facility, and as a result of insurance and billing issues related to the medication. Resident 3 (R3)’s medication order received on 2/25/2026 to discontinue Celebrex 200mg twice daily was not implemented, and R3 continued to receive the medication until 3/31/2026. Resident 4 (R4)’s medication order for Methocarbamol 750mg was updated to four times daily for 3 days for increased back pain from 3/18/2026 to 3/20/2026. However, the order was written in the MAR as a PRN order, so the medication was not given as prescribed. Based on interviews conducted and records reviewed, the allegation that Staff did not properly assist with the self-administration of medications is Substantiated at this time.

On the allegation, Staff do not refill resident’s medication prescription in a timely manner: It has been alleged that Resident 1’s (R1’s) medications were not refilled causing R1 to miss their prescribed medications. Record review revealed Resident 1 (R1) reported to their responsible party via text message on 2/10/2026 at 8:00 am, “No anti depressant pill Effexor this am…told ‘Staff’ to talk to ‘Staff’ or look for one. Again a screw up. Without the most important meds I’ll go into a depression…just thinking about it gets me depressed and sweaty”; Responsible Party replied, ‘Dr.’s office is going to call…and take it to you as soon as it’s ready’; R1 replied ‘Staff” found two 75mg’…
Review of R1’s Medication Administration Record (MAR) revealed the following: R1 was prescribed Pantoprazole Sodium F/C 40mg tablet 1 tab by mouth twice daily before breakfast and dinner. Start date: 12/12/2025; End: 3/15/2026. LPA reviewed R1’s Medical Administration Record (MAR) for January 2026, February 2026 and March 2026. Record review of R1’s MAR revealed staff initialed “Medication Not Available” in January, February, and March of 2026. LPA noted January 2026 MAR reveals “Medication Not Available” verified by initials as follows: one (1) entry noted by Staff 1 (S1); thirteen (13) entries noted by Staff 2 (S2);

Please continue to 9099-C, Pg 3.

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

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20260309111520
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: VILLA SANTA BARBARA
FACILITY NUMBER: 425850241
VISIT DATE: 05/05/2026
NARRATIVE
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one (1) entry noted by Staff 3 (S3); two (2) entries noted by Staff 4 (S4); five (5) entries noted by Staff 5 (S5); six (6) entries noted by Staff 6 (S6); one (1) entry by Staff 7 (S7); and eight (8) entries noted by Staff 8 (S8). LPA noted February 2026 MAR reveals “Medication Not Available” verified by initials as follows: fifteen (15) entries noted by S2; five (5) entries noted by S4; three (3) entries noted by S5; three (3) entries noted by S7; three (3) entries noted by S8; and six (6) entries noted by S9. LPA noted March 2026 MAR reveals “Medication Not Available” verified by initials as follows: seven (7) entries noted by S2; two (2) entries noted by S4; three (3) entries noted by S5; two (2) entries noted by S8; and 1 entry noted by S9.

R1 was prescribed Triamterene-Hydrochlorothiazide 37.5-25mg capsule by mouth, start date 1/7/2026. MAR notes “Condition: Essential (primary) hypertension. LPA reviewed R1’s Medical Administration Record (MAR) for January 2026, February 2026, and March 2026. Record review of R1’s MAR revealed staff initialed “Medication Not Available” in January, February, and March of 2026. LPA noted January 2026 MAR reveals “Medication Not Available” verified by staff initials as follows: four (4) entries noted by S2, and five (5) entries noted by S5. LPA noted February 2026 MAR reveals “Medication Not Available” verified by staff initials one (1) entry noted by S2; and one (1) entry noted by S5.

R1 was prescribed Valacyclovir F/C 500mg tablet by mouth twice daily. Start date 1/12/2026, end date 2/2/2026: MAR states Herpesviral infection, unspecified. LPA reviewed R1’s Medical Administration Record (MAR) for January 2026 and February 2026. Record review of R1’s MAR revealed staff initialed “Medication Not Available” in January 2026 and February 2026. LPA noted January 2026 MAR reveals “Medication Not Available” verified by staff initials as follows: two (2) entries noted by S2, one (1) entry noted by S5, three (3) entries noted by S6, and two (2) entries noted by S8. LPA noted February 2026 MAR reveals “Medication Not Available” verified by staff initials as follows: one (1) entry by S2; one entry by S5; one (1) entry by S7, and one (1) entry by S9.

Based on interviews conducted and records reviewed, the allegation that staff do not refill resident’s medication in a timely manner is Substantiated at this time.

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

Exit interview conducted. Copy of report and Appeal Rights issued via email.

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

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20260309111520
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: VILLA SANTA BARBARA
FACILITY NUMBER: 425850241
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/07/2026
Section Cited
CCR
87465(c)(2)
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Incidental Medical and Dental Care: (2) Once ordered by the physician the medication is given according to the physician's directions.

This requirement is not met as evidenced by:
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Licensee agrees to submit written Plan in Place to ensure medications are administered per Physician's orders including changes and/or updates to medications and/or residents' changes in condition. Written plan will be submitted to LPA via email no later than due date (5/7/2026).
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Based on record review and interviews conducted, the licensee did not comply with the section cited above when staff did not give medications as prescribed for multiple residents, which posed an immediate health and safety risk to residents in care.
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Type A
05/07/2026
Section Cited
CCR
87465(a)(4)
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Incidental Medical and Dental Care: The licensee shall assist residents with self-administered medications as needed.

This requirement is not met as evidenced by:
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Licensee agrees to submit written Plan in Place to ensure timely refills, changes in medication orders, and resident's change of condition. Written plan will be submitted to LPA via email no later than due date (5/7/2026).
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Based on record review and interviews conducted, the licensee did not comply with the section cited above when R1’s MAR repeatedly noted “Medications Not Available” consecutively in January 2026, February 2026, and March 2026 posing an immediate health and safety 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.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4