565802425-4-30-2021-29-AS-JAPL-C2Y2D7-20210512171750

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802425
Report Date: 04/30/2021
Date Signed: 04/30/2021 01:53:06 PM

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
04/27/2021 and conducted by Evaluator Kasandra Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20210427092848

FACILITY NAME:	PACIFICA SENIOR LIVING OXNARD		FACILITY NUMBER:	565802425
ADMINISTRATOR:	MARKOVICH, PAUL		FACILITY TYPE:	740
ADDRESS:	2211 E GONZALES RD		TELEPHONE:	(805) 983-6808
CITY:	OXNARD	STATE: CA	ZIP CODE:	93036
CAPACITY:	100	CENSUS: 47	DATE:	04/30/2021
		UNANNOUNCED	TIME BEGAN:	10:44 AM
MET WITH:	Sara Gutierrez		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Staff did not deliver mail to residents
Staff opened residents mail without their consent

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced initial complaint inspection. At 10:46 AM the LPA met with Executive Director Sara Gutierrez and explained the reason for today's inspection.

At 11:07 AM the LPA began resident interviews. Between 11:07 AM and 12:09 PM the LPA conducted interviews with Resident #1, Resident #2, Resident #3, Resident #4, Resident #5, Resident #6, Resident #7, and Resident #8. At 12:16 PM the LPA conducted an interview with Administrator Sara Gutierrez.

The allegations allege packages were hand delivered for approximately 12 residents to the facility but the packages were opened and not delivered to the residents.

Report continued on LIC 9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2021

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-20210427092848

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: PACIFICA SENIOR LIVING OXNARD	FACILITY NUMBER: 565802425
	VISIT DATE: 04/30/2021

NARRATIVE

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Interviews with residents revealed, two out of the eight residents interviewed were aware of a package that was to be delivered to them but it was never received. The other residents interviewed were not aware of any missing or opened packages.

The interview with Ms. Gutierrez revealed an unknown delivery person hand delivered about 10 small packages on April 15, 2021 to the facility. The packages were addressed to the residents and did not state who the packages were from and the delivery person would not disclose the sender. For security concerns, the packages were taken to Ms. Gutierrez who said she opened the packages and found two unwrapped cookies and marketing items from another assisted living facility. Ms. Gutierrez stated she informed corporate and they advised to not deliver the items to the resident. Ms. Gutierrez stated the packages are no longer in her possession.

Based on the information obtained, there is sufficient evidence to support the allegations of "Staff did not deliver mail to residents" and "Staff opened residents mail without their consent". Therefore, the allegations are substantiated.

The following deficiency was observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. The report was signed by the administrator. A copy of the report and appeals rights will be emailed to the administrator by the end of the day.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2021

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20210427092848

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: PACIFICA SENIOR LIVING OXNARD	FACILITY NUMBER: 565802425
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/30/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/06/2021 Section Cited CCR 87468.1	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (15) To send and receive unopened correspondence in a prompt manner. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The administrator reviewed regulation 87468.1 during the inspection and understands the violation and agrees to comply in the future. The administrator stated they no longer have the packages but agreed to advise the residents of the undelivered packages and the items they did not receive.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply with the section cited above, as the interview with the administrator and interviews with two out of eight residents revealed, resident packages were opened and not given to the residents they were intended for, which poses a personal rights risk to residents in care.	8 9 10 11 12 13 14	A written and signed statement by the administrator was given to the LPA during the inspection. Plan of correction cleared.
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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.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2021

LIC9099 (FAS) - (06/04)

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