565802425-1-23-2023-29-AS-JAPL-CNH4X4-20230127182855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802425
Report Date: 01/23/2023
Date Signed: 01/23/2023 03:37:37 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
01/19/2023 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20230119090203

FACILITY NAME:	PACIFICA SENIOR LIVING OXNARD		FACILITY NUMBER:	565802425
ADMINISTRATOR:	KORTNIE SPITZNOGLE		FACILITY TYPE:	740
ADDRESS:	2211 E GONZALES RD		TELEPHONE:	(805) 983-6808
CITY:	OXNARD	STATE: CA	ZIP CODE:	93036
CAPACITY:	100	CENSUS: 51	DATE:	01/23/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Kortnie Spitznogle		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Licensee is not keeping facility free of rodents

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Ashley Smith and Angel Ascencio arrived unannounced to conduct an initial complaint visit. The LPAs met with Executive Director (ED) Kortnie Spitznogle and explained the reason for the visit.

Today, the LPAs toured the kitchen at 10:15 a.m., interviewed staff at 10:20 a.m., 12:23 p.m., 1:31 p.m., 1:35 p.m., and interviewed residents at 12:30 p.m., 12:35 p.m., 12:56 p.m., 1:40 p.m., and 2:05 p.m.

Regarding the allegation, it is alleged that there were rat droppings in the kitchen, specifically on the floor, countertops, and kitchen equipment. The ED admitted that the facility has an issue with rats in the kitchen. The ED mentioned that a staff person had observed a rat coming through the vents in the kitchen. The ED claimed that the pest control company Terminex has provided monthly service to the facility since October 2022 and noted that the company recently came out on 1/13/2023 and submitted a proposal for a concentrated treatment in the kitchen only.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023

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-20230119090203

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: 01/23/2023

NARRATIVE

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However, at 10:20 a.m., the LPAs and the Executive Director (ED) toured the kitchen area of the facility. The LPAs and the ED observed rat droppings on the floor, on top of kitchen counters, and on top of kitchen equipment. Information obtained from interviews supported claims that persons have either observed rat droppings in the kitchen or have heard about the presence of rats in the kitchen. This facility was recently cited for an allegation of rats in the facility on 10/13/2022. The ED admitted that the rat problem has been a chronic issue. Based on observation and interview, the above allegation is Substantiated at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D).

Exit interview conducted. Appeal Rights Discussed. A copy of the report was provided. Civil penalty assessed.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230119090203

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: 01/23/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/24/2023 Section Cited CCR 87555(b)(27)	1 2 3 4 5 6 7	87555(b)(27) General Food Service Requirements. All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Executive Director agreed to do the following: 1. Submit a written plan of action, detailing how the facility will maintain compliance with the regulation. Indicate the steps the facility is taking to manage the pest concern on a daily basis.
	8 9 10 11 12 13 14	Based on interviews and observations, the licensee did not comply with the section cited above, as there were rodent droppings observed in the kitchen and staff admitted that the facility had an issue with rodents in the kitchen, which poses and immediate health and safety risk to persons in care.	8 9 10 11 12 13 14	Submit Plan of Action no later than 1/24/2023, end of day. The facility was cited for this regulation on 10/13/2022, civil penalty of $250 assessed.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023

LIC9099 (FAS) - (06/04)

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