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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802425
Report Date: 01/06/2023
Date Signed: 01/06/2023 05:23:44 PM

Substantiated


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
10/06/2022 and conducted by Evaluator Angel Ascencio
COMPLAINT CONTROL NUMBER: 29-AS-20221006083747
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: 50DATE:
01/06/2023
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Cynthia GarciaTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Staff are not meeting residents’ dietary restrictions
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angel Ascencio conducted a subsequent visit to the facility above to deliver findings. LPA Ascencio met with Business Office Manager (BOM) Cynthia Garcia 2:27 pm. Administrator Kortnie Spitznogle was not able to be present. Entrance interview conducted.

On 10/06/2022, the Department received a complaint alleging that staff are not meeting resident’s dietary restrictions. During a facility tour on 10/13/2022, LPA Ascencio observed a dietary list, in the kitchen, that had the restrictions or modified diets for each resident at the facility. On 10/13/2022 and 01/04/2023, LPA Ascencio conducted eight (8) resident interviews. Interviews with residents revealed that most of the time, residents are unaware of what is being served during mealtimes. Residents stated that the facility staff know they have dietary restriction yet don’t provide alternative options for food items.

Continued on LIC 9099 - C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
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 5
Control Number 29-AS-20221006083747
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: 01/06/2023
NARRATIVE
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Further interviews revealed that some of the residents’ dietary need are as follows: low sodium, heart health, and diabetic. Various resident stated they have restrictions on diets, but facility staff continues to provide every resident with pastas, burgers, sandwiches, fries, fried foods, and pancakes during mealtimes. There are days that there are healthy options or they get restrictions right, but most of the time its food items we know we cannot eat, we cannot have or it bad. Interviews with six (6) staff members on 10/13/2022 and 01/04/2023, revealed that some staff claim they do their due diligence in ensuring that the residents dietary needs are met. Staff interviews also indicated that due to an inadequate supply of perishable and nonperishable foods as it relates to the daily menus, staff believe they are unable to meet resident dietary needs as prescribed for low sodium, heart health and diabetic. A similar complaint, reported to the Department on 10/12/2022 relating to food quality and requirements, was substantiated. Based on evidence gathered throughout the investigation, the allegation is deemed substantiated at this time.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20221006083747
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: 01/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/13/2023
Section Cited
CCR
87555(b)(7)
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87555 General Food Service Requirements (b) (7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided.

This requirement is not met as evidence by:
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Administrator will conduct kitchen staff training on modified diets. Administrator will provide residents with modified diets and alternative food option to adhere with the physician’s order. Administrator will submit training to LPA by 1/13/2022.
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Based on interviews, the licensee did not comply with the section cited above as modified diets prescribed by resident physicians have not been followed which poses a potential health, safety and personal rights risk to resident in care.
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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: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
10/06/2022 and conducted by Evaluator Angel Ascencio
COMPLAINT CONTROL NUMBER: 29-AS-20221006083747

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: 50DATE:
01/06/2023
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Cynthia GarciaTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Resident are being locked inside the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angel Ascencio conducted a subsequent visit to the facility above to deliver findings. LPA Ascencio met with Business Office Manager (BOM) Cynthia Garcia 2:27 pm. Administrator Kortnie Spitznogle was not able to be present. Entrance interview conducted.

On 10/06/2022, the Department received a complaint alleging that residents are being locked inside the facility. On 10/13/2022, LPA Ascencio conducted an interview with Administrator Kourtney Spitznogle at 1:16 p.m. Interview with Administrator Spitznogle revealed that during the weekdays, there is no reception after 7:00 p.m. and on weekends, there is no reception after 5 p.m. Administrator Spitznogle added that they have asked Pacifica Senior Living Corporation to increase the weekend reception hours to 7:00 p.m., but have been unsuccessful. Administrator continued, after the reception desk closes at 5:00 p.m., the main entrance door does get locked, but resident continue to have the freedom to leave the community.
Continued on LIC 9099 - C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20221006083747
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: 01/06/2023
NARRATIVE
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Once the resident or visitor comes up to the front entrance, there is a phone number that they can call, and a staff member will open the door. Interview with Resident #1 (R1) on 10/14/2022 revealed that R1 has had no problem leaving the facility after reception was done for the day at 5:00 p.m. R1 lastly added that they have heard of other residents and visitors trying to get into the facility after hours and having to wait due to a shortage of staff in the evening. Additional interviews with residents on 10/13/2022 and 1/4/2023 revealed that they don’t feel like they are locked in the facility, but the main problem is someone not opening the main door after hours. Interview with R2, on 10/13/2022 starting at 1:40 p.m., revealed that R2 was able to leave the facility without any problem but had to wait 20-30 minutes outside on various occasions before the door was opened for R2.

Although the allegation has been determined to be unsubstantiated, a conversation was held with the Business Office Manager during the exit interview of today’s visit. LPA stressed the importance of knowing clients’ personal rights and having sufficient staff to address the needs of residents. BOM stated they will continue to hire staff.

Copy of the report provided to Administrator via email.

SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel AscencioTELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5