425850241-5-30-2024-29-AS-KBUY-D6EVXU-20240620165007

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850241
Report Date: 05/29/2024
Date Signed: 05/30/2024 10:07:45 AM

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
05/14/2024 and conducted by Evaluator Kristin Kontilis

COMPLAINT CONTROL NUMBER: 29-AS-20240514113058

FACILITY NAME:	GARDEN COURT AT VILLA SANTA BARBARA		FACILITY NUMBER:	425850241
ADMINISTRATOR:	ROBERT GLOCK		FACILITY TYPE:	740
ADDRESS:	227 E. ANAPAMU STREET		TELEPHONE:	(805) 963-4428
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93101
CAPACITY:	126	CENSUS:	DATE:	05/29/2024
		UNANNOUNCED	TIME BEGAN:	03:08 PM
MET WITH:	Robert Glock, Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff did not meet resident's needs.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Kristin Kontilis conducted a subsequent complaint visit to the facility above to issue final findings. LPA met with Robert Glock, Administrator, and Tina Tran, Wellness Director and explained the purpose of the visit.
During the investigation, LPA Kontilis conducted an initial visit on 5/22/2024 from 10:14 am to 3:45 pm, toured the facility, obtained documents, and interviewed staff.
On the allegation: Facility staff did not meet resident's needs. It was reported Resident 1 (R1) sustained pressure injuries at the facility. The investigation revealed on 4/18/2024, R1 moved into the facility from a Skilled Nursing Facility. On 4/26/2024, R1 fell and went to the hospital. At the hospital, it was discovered R1 had “sores” on their back side and groin that were believed to be consistent with sitting in a soiled brief too log. A witness interviewed confirmed R1 was at the facility for only about one week before they went to the hospital. On 5/8/2024, R1 returned to the facility and was placed on hospice. Witness originally stated they observed the “sores,” then later stated they did not personally observe them.
Please continue to 9099-C, Pg 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

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-20240514113058

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: 05/29/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Witness interviewed stated R1’s skin could have been breaking down due to their health decline.
LPA reviewed R1’s physician’s report dated 2/21/2024, which states R1 had diagnoses including stage IV colorectal cancer, adrenal insufficiency, mild cognitive impairment, and hypothyroidism. The physician’s report also indicates R1 had some bladder impairment, no bowel impairment, no history of skin breakdown, is able to follow instructions and communicate needs. It also states R1 needs assistance with bathing, should have some supervision toileting but is able to care for own needs, and needs verbal prompting to dress/groom self. The physician’s report does not mention any pressure injuries or wounds.
R1’s pre-admission appraisal dated 4/10/2024 states R1’s overall skin condition and skin color is “normal,” and states there are no active wounds or areas of active skin issues. The appraisal states R1 is independent with mobility, needs limited assistance with transferring, and is independent in repositioning. R1 requires minimal assistance with bathing but may require reminders, set up or standby assistance; requires minimal assistance with grooming/personal hygiene and dressing but requires verbal reminders or set up assistance; requires minimal assistance with toileting including verbal prompts and may ask for standby assistance, and states the resident is usually continent but may use adult briefs. The appraisal also states the resident has been educated on how to use their call button system for staff assistance, and R1 was coherent and able to communicate. The appraisal does not indicate R1 had any pressure injuries or wounds.
LPA reviewed an internal incident report dated 4/21/2024 that R1 had a sliding fall when trying to get into a car. Staff notified R1’s doctor of the fall. LPA reviewed an internal incident report dated 4/26/2024 that indicated on 4/26/2024 R1 had an episode of vomiting, complained of back pain, and was sent to the hospital. The incident reports indicate staff were checking on R1. Interviews with staff revealed that facility caregivers checked on R1 multiple times a day and assisted R1 with activities of daily living (ADLs) as needed.
R1’s discharge paperwork from the hospital dated 5/8/2024 notes diagnosis of principle pyelonephritis on 4/26/2024. The discharge paperwork does not indicate any pressure injuries, wounds or sores on R1’s skin. The discharge paperwork does state in addition to the pyelonephritis, R1 had macrocytic anemia. Interviews with administrator and wellness director revealed R1’s anemia led to increased weakness and pale skin. Wellness director, who is an RN, also stated if R1 had sores, they could have taken longer to heal due to the Anemia.
Please continue to 9099-C, Pg 3.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20240514113058

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: 05/29/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

R1 was discharged from the hospital back to the facility and placed on hospice. R1’s responsible party chose to have private caregivers come in and provide additional care to R1, along with hospice. Someone on R1’s care team was present with R1 at all times from 5/8/2024 until they passed away. In addition, Administrator and Wellness Director stated facility staff also checked on R1 and checked in with R1’s private care team multiple times per day.
R1’s hospice care plan dated 5/8/2024 and updated 5/11/2024 does not indicate R1 had any pressure injuries, wounds or sores. R1 passed away on hospice and was unable to be interviewed.
Based on the investigation, R1 only required minimal care assistance when they moved into the facility and was able to communicate their needs to staff. R1 was not officially diagnosed with any pressure injury, sore or wound per hospital and hospice paperwork. There was insufficient evidence to prove the allegation Facility staff did not meet resident's needs. Therefore, the allegation is deemed Unsubstantiated at this time.

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

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3