565802425-2-22-2023-29-AS-JAPL-CPG6AR-20230227193842

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802425
Report Date: 04/25/2022
Date Signed: 02/22/2023 03:37:36 PM

Unsubstantiated

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
04/25/2022 and conducted by Evaluator Angel Ascencio

COMPLAINT CONTROL NUMBER: 29-AS-20220425095729

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: 56	DATE:	04/25/2022
		UNANNOUNCED	TIME BEGAN:	10:01 AM
MET WITH:	Kortnie Spitznogle		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident's apartment is not kept at a comfortable temperature

INVESTIGATION FINDINGS:

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This report was amended on 02/22/2022 to add pertinent information. Licensing Program Analyst (LPA) Angel Ascencio and Kelly Dulek conducted an unannounced complaint visit to the facility above. LPA’s met with Administrator Kortnie Spitznogle at 10:05 am. Entrance interview conducted.
It is being alleged that resident's apartment is not kept at a comfortable temperature. On 4/25/2022 starting at 12:32 p.m. to 1:52 p.m. interviews with Resident #1 (R1), R2 and R3 revealed that they have not had any issues with their temperature being to high or too low. When the temperature is needing to be adjusted, resident will call staff for help if they cannot figure it out themselves. During a visit on 02/22/2023, the LPAs checked the temperature in R1’s room and throughout the facility, and conducted additional resident interviews. Room temperatures in six (6) resident rooms and two (2) common areas were tested and was at a comfortable range between 67.5 degree F and 72.7 degree F. Resident interviews and temperature readings in resident rooms and common areas indicated that the rooms were in a range of 68 degree F and 85 degree F per regulation. Based on the investigation, the above allegation is unsubstantiated at this time. Exit interview conducted. Copy of the report provided to BOM.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022

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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