<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802425
Report Date: 05/06/2022
Date Signed: 05/06/2022 03:36:39 PM


Document Has Been Signed on 05/06/2022 03:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 OXNARDFACILITY NUMBER:
565802425
ADMINISTRATOR:KORTNIE SPITZNOGLEFACILITY TYPE:
740
ADDRESS:2211 E GONZALES RDTELEPHONE:
(805) 983-6808
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:100CENSUS: 55DATE:
05/06/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Kortnie SpitznogleTIME COMPLETED:
03:15 PM
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
Licensing Program Analyst (LPA) Angel Ascencio conducted a Case Management - Incident visit regarding a phone call and an incident report that was received on 05/05/2022 regarding an inappropriate touching between staff and resident. LPA met with Executive Director (ED) Kortnie Spitznogle.

During today’s visit on 05/06/2022, LPA Ascencio interviewed ED Spitznogle starting at 1:02 p.m. During the interview, it was revealed that Resident #1 (R1) and Staff #1 (S1) were sitting in the Memory Care activity room by the window. R2 came over to see R1 for dinner, witnessed S1’s hand on the inner thigh of R1. R2 did not say anything to S1 but proceeded to head to dinner with R1. About one (1) week later, R2 notified the Memory Care Director (MCD) of what he had witnessed. MCD proceeded to notify Resident Care Director (RCD) who then proceeded to let ED know on 05/04/2022, who then notified LPA Ascencio that same day at approximately 7:00 p.m. Further interview with ED revealed that on 05/05/2022, ED and Business Office Manager (BOD) had a conversation with R1 and R2. During their interview, R2 stated that S1’s hand placement was on the upper thigh region, on the outside of R1’s pants. R2 added that S1’s hand placement was too close for R2’s comfort. R2 also added that they believe it was an innocent act, but it made R2 feel uncomfortable. Interviews with R1 and R2 on 05/06/2022, starting at approximately 2:05 p.m. revealed that everything that was discussed with ED was accurate. R2 added that they saw the act as innocent but that S1 had no business putting their hands in between R1 thigh. R1 added that they have not been touched inappropriately by any staff or resident. R1 also stated they would report any act of inappropriateness to a person with authority. Later that day, starting at 2:20 p.m., staff interviews revealed that they have not heard or witnessed any resident make comment regarding inappropriate behavior from a resident or staff member. Staff interviews also revealed that if they were to hear of any misconduct from staff or residents, they would directly notify their manager, community care licensing or the ombudsman office.

Based on evidence gathered, there was no citation made during today’s visit. Copy of the report provided to ED via email.

SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1