425850241-12-11-2023-29-AS-KBUY-CYQ3CK-20231220170803

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850241
Report Date: 12/11/2023
Date Signed: 12/11/2023 03:52:27 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
10/04/2023 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20231004170559

FACILITY NAME:	GARDEN COURT AT VILLA SANTA BARBARA		FACILITY NUMBER:	425850241
ADMINISTRATOR:	RICK OLDS		FACILITY TYPE:	740
ADDRESS:	227 E. ANAPAMU STREET		TELEPHONE:	(805) 963-4428
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93101
CAPACITY:	126	CENSUS: 93	DATE:	12/11/2023
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Bill Ferguson, Business Director		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

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Staff are refusing to allow resident to remove their personal belongings from the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA's) Olson and Miller conducted an unannounced subsequent complaint visit to issue final findings on the allegation above. LPA obtained documents and interviewed staff on 10/11/23 at 1:30pm and 2pm. LPAs met with Business Director and explained the purpose of the visit.

On the allegation: Staff are refusing to allow resident to remove their personal belongings from the facility. It was alleged on 10/2/23 Administrator refused to allow the moving company to pick up R1’s equipment and demanded to speak with the patient before releasing the equipment. LPA interviewed Administrator and Wellness Director who stated they met with R1 on 9/27/23 and 9/29/23 relaying their wishes to return to the facility. Administrator stated they had new equipment ordered such as a hospital bed and Hoyer lift to help R1 come home. On 9/29/23 R1 stated they were ready to come home.
On 9/30/23 Administrator went to the SNF to pick up the resident but was denied access and told the resident would not be going back to Garden Court but remaining at their current facility. R1’s family member (FM1) and friend came out to talk with Administrator who then called the Wellness Director. (Continued on 9099-C)

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: 12/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

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-20231004170559

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: GARDEN COURT AT VILLA SANTA BARBARA	FACILITY NUMBER: 425850241
	VISIT DATE: 12/11/2023

NARRATIVE

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Both Administrator and Wellness Director stated they needed to speak to the resident for confirmation. Wellness Director stated they asked if R1 had a POA and no one answered. FM1 stated they became R1's POA when they signed the Hospice admission. Wellness Director asked for a copy and never received it. Both Wellness Director and Administrator stated R1 was responsible for themselves and had no Responsible Party or POA. LPA reviewed R1’s Admission Agreement and Emergency Contact paperwork. LPA observed there to be no responsible party listed on R1’s Admission Agreement. LPA observed no POA paperwork in R1’s file. LPA observed R1’s emergency contact to be FM2.

Administrator stated on 10/2/23 they did ask the company picking up R1’s equipment to wait so they could confirm with the resident they were not coming back. Administrator stated they were under the impression R1 was returning and was surprised they were picking it up. Once Administrator spoke with R1’s family and stated they made the decision for R1 not to return they allowed the company to take the equipment and stated to LPA it was about an hour later. Administrator stated on 10/6/23 the family came to move out R1’s things and they removed all of R1’s belongings. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

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: 12/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

LIC9099 (FAS) - (06/04)

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