425850335-1-31-2025-29-AS-KBUY-DEATT9-20250227140018

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850335
Report Date: 01/31/2025
Date Signed: 01/31/2025 12:55:52 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
01/24/2025 and conducted by Evaluator Melisa Rankin

COMPLAINT CONTROL NUMBER: 29-AS-20250124113053

FACILITY NAME:	GRANVIDA SENIOR LIVING AND MEMORY CARE		FACILITY NUMBER:	425850335
ADMINISTRATOR:	TERRILL, ERIC		FACILITY TYPE:	740
ADDRESS:	5464 CARPINTERIA AVENUE		TELEPHONE:	(805) 566-0017
CITY:	CARPINTERIA	STATE: CA	ZIP CODE:	93013
CAPACITY:	83	CENSUS: 63	DATE:	01/31/2025
		UNANNOUNCED	TIME BEGAN:	08:52 AM
MET WITH:	Charles Eusey		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff are not implementing proper infection control practices at the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rankin conducted a 10-day complaint visit to the facility above. LPA met with the new administrator, Charles Eusey, and explained the purpose of the visit.

Allegation: Staff are not implementing proper infection control practices at the facility
LPA requested and received the following documents: Current Infection Control Plan dated 12/10/22, Infection Control Training documents from July 2024 to current, Staff Roster with notation of staff who have been sick with flu like symptoms the month of January, and Resident roster with notation of residents who have been sick with flu like symptoms during the month of January.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

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-20250124113053

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GRANVIDA SENIOR LIVING AND MEMORY CARE	FACILITY NUMBER: 425850335
	VISIT DATE: 01/31/2025

NARRATIVE

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Continuation Page 2
LPA toured the facility during the interviews. LPA observed the Memory Care (MC) unit, the Assisted Living (AL) halls on floor 1 and 2, dining facilities, activity room, art room, and lobby visiting area. All areas are spacious and allow for staff and residents to be spread out within their comfort level. LPA also went to the basement storage area, where the following PPE was observed gowns, gloves, masks, and booties.

LPA interviewed 3 residents. LPA interviewed Resident #1 (R1) and Resident #2 (R2). Interview was done in the lobby visiting area. R1 stated R1 had been sick for about 3 days, with diarrhea, R1 stated they did not participate in bingo or the activities for a couple of days, but they were feeling better. R2 stated they had not been sick, nor did they know of anyone else who had been sick with the exception of R1. Both residents thought that staff had been coming to work sick because they saw staff wearing masks about 1 – 2 weeks ago, they were unsure of the timeline, but knew it was more recent. Resident #3 (R3) was interviewed by the LPA in their private living room. When LPA stated they were there regarding a concern of an outbreak of an illness, R3, with wide eyes stated “this is the first I’ve heard of there being one.” R3 stated they participate in all lunches and dinners as well as bingo. LPA asked if there had been residents missing from these activities, R3 stated there is always 1 or 2 because they have things going on, but nothing out of the ordinary, and they did not observe any staff or residents in any of these areas to be ill. R3 stated staff do a great job of showing up to clean and support their needs, there are no complaints from R3.

LPA interviewed 5 staff and the administrator. Interview with Staff #1, #2, and #3 were done in the lobby, the visiting area, and in the dining room. All 3 staff indicated about a week or 2 ago there was some residents who were ill. All 3 stated they thought there were 4 – 8 residents who were ill with diarrhea and vomiting. S1 and S2 stated they observed that the cross over from MC and AL ceased for about a weeks’ time. S2 stated they did know of 2 – 3 staff who were sick, but only for a few days. S1 and S3 are not aware of any staff being sick. Staff were asked to wear masks and increase use of gloves. S1 stated there are disposable utensils and plates if needed for residents.

Staff #4 (S4) was interviewed in the MC unit. S4 assists with staffing, S4 stated about 2 weeks ago they did have 5 residents in MC who were ill about the same time. Increase cleaning was done, separation of MC residents from AL residents was done as soon as they realized a couple of residents were sick. Isolation as much as could be done in the MC area was done to prevent other MC residents from getting ill. Only the 5 residents were ill. The caregivers were staffed so they didn’t work in AL and MC. Increase
Continued 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20250124113053

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GRANVIDA SENIOR LIVING AND MEMORY CARE	FACILITY NUMBER: 425850335
	VISIT DATE: 01/31/2025

NARRATIVE

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Continuation - Page 3
cleaning was done in the restroom areas, the residents’ rooms, and in the common area of the MC. S4 stated that some residents expressed concern that something was happening due to staff wearing masks. Residents were told that staff are being cautious to keep residents from getting ill. Staff were not wearing masks due to their own illness. Disposable plates and silverware were used for residents in MC during this time.

Staff #5 (S5) was interviewed in the MC. They mainly work in MC and stated they worked hard to keep areas clean and dispose of anything that could have been contaminated. S5 stated meals for those residents who were ill were served on disposable plates. Tables were cleaned more regularly, and gloves were swapped out more and used for all services, including serving meals. S5 who works directly in care giving state they had enough PPE and felt secure that if needed management would have provided more items.

LPA inquired with the administrator regarding next steps if they had an outbreak. Administrator explained their process which was in line with Title 22 regulations. Next steps would have been for residents to isolate, dining and activities would have been closed, visiting would have been stopped or screened, and reporting to Community Care Licensing as well as Public Health would have been initiated. Administrator stated no residents were transferred out due to diarrhea or vomiting and at this time, to his knowledge, no other resident or staff is exhibiting these symptoms.

Part of the Reporting Parties concern was a staff member had been hired, had gotten ill, and had passed away recently, but Administrator confirmed that a staff member had an expected death in the family, which was unrelated to any current illness in the facility during the month of January.

LPA reviewed the facilities Infection Control Plan and discussed with administrator.

Although the allegation may have happened, there is not a preponderance of evidence, based on interviews with residents, staff, and records obtained, to prove the alleged violation occurred; therefore, the allegation is unsubstantiated.

Exit interview conducted, copy of report printed for Administrator.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

LIC9099 (FAS) - (06/04)

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