565802425-2-15-2023-29-AS-JAPL-CPG6AQ-20230227193841

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802425
Report Date: 02/15/2023
Date Signed: 02/15/2023 01:53:32 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
04/25/2022 and conducted by Evaluator Ashley Smith

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: 47	DATE:	02/15/2023
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Kortnie Spitznogle		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff do not respond to resident's call for assistance
Resident's diapering needs are not met in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith a subsequent complaint visit, to deliver findings to the above facility. The met with Executive Director Kortnie Spitznogle and explained the reason for the visit. Entrance interview conducted.

The Woodland Hills North Regional Office (RO) received a complaint on 04/25/2022 regarding staff do not respond to residents’ calls for assistance, facility food service is inadequate and resident’s food service is inadequate.

CONT on 9099-C

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: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

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-20220425095729

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: 02/15/2023

NARRATIVE

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Regarding the allegation: staff do not respond to residents’ calls for assistance
On 04/25/2022, starting at 1:48 p.m., LPA interviewed Resident #1 (R1). Interview with R1 revealed that they have a pendant that continuously breaks. R1 stated, on the days that the pendant is functioning properly, it takes about 20 minutes or more for staff to help. When the pendant is not working, R1 indicated that staff takes the pendant button to fix it but don’t return it for a few days later. Interview with Executive Director (ED) Kortnie Spitznogle on 04/25/2022, starting at 2:45 p.m. revealed that R1 has a working pendant but they continuously push it when help does not arrive. It was communicated that staff had it replaced multiple times because R1 pushes it too hard it breaks. Staff indicated that R1 gets handed a new pendant within a day or two. R1 is on a 2-hour check-up, based on R1’s Needs and Service Plan. In addition, the facility Business Office Manager (BOM) conducts a monthly test on all pendants for servicing.

On 2/15/2023, starting at 12:00 p.m., LPA Smith reviewed the SMARTcare Alert Call Button report for Resident #1 (R1). Regarding R1, it was indicated that out of the four (4) instances where R1 pressed their pendant in April 2022, there was one (1) alert that failed to receive a response, and the other three (3) alerts were responded to in a timely manner. However, R1’s pendant button was reportedly to be regularly in disrepair. As such, R1 is unable to call for assistance as needed. As a result, the provided logs may not fully represent the time(s) in which R1 required assistance, or when R1 was without a button and still required assistance. R1 also reported that they would sometimes have to yell for assistance.

On 01/23/2023, LPA Ascencio reviewed the SMARTcare Alert Call Button report for three (3) different residents. Review of the call button report revealed that from 11/06/2022 through 12/02/2022, there was seventeen (17) alert button announcements that have elapsed the company’s fifteen (15) minute policy. Further review of the SMARTcare report also revealed that there were five (5) alerts that were never responded to from 11/06/2022 – 12/02/2022.

Based on the information from the investigation, there is sufficient evidence to support the claim that staff are not responding to residents’ calls for assistance in a timely manner. A similar complaint was substantiated on 10/25/2022. Based on record review and interview, the allegation is substantiated at this time.

CONT 9099-C

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220425095729

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: 02/15/2023

NARRATIVE

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Regarding the allegation: Resident's diapering needs are not met in a timely manner.

On 04/25/2022, starting at 1:48 p.m., LPA interviewed R1. Interview with R1 revealed that when R1 calls staff for toileting needs, staff show up to help 20-30 minutes later, or don’t respond at all. R1 stated they have incontinence issues and would prefer to use the restroom but cannot make it due to their physical limitation. Lastly, R1 added they rely on staff for toileting need and incontinence assistance. On 01/31/2023, starting at 12:05 p.m., review of R1’s Needs and Service Plan revealed that R1’s bathing, toileting, and bowel incontinence require total assistance. Review of Hospice records on 01/31/2023, starting at 12:40 p.m. revealed that on 06/06/2022, Hospice Representative found R1 saturated in urine, dry stool in groin area, and stool under draw sheet. Interview with Hospice Representative on 06/24/2022, starting at 9:45 a.m., confirmed that R1 was found saturated in urine and stool. Although there was insufficient evidence for R1s need not being met, interviews with resident and outside agency revealed that residents diapering need are not met in a timely manner as R1 was found saturated in urine and dry stool in groin area. Therefore, the allegation resident’s diapering needs are not met in a timely manner are 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 809-D):

Exit interview conducted. Civil penalties assessed. A copy of the report, along with appeal rights, were provided.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220425095729

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: 02/15/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/20/2023 Section Cited CCR 87468.1(a)(2)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a)(2) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Executive Director agreed to the following: 1. Review policies and procedures around responding to pendants and addressing diapering needs to all staff. Send sign-in sheet to CCL no later than 2/20/2023.
	8 9 10 11 12 13 14	Based on record review and interviews, the licensee did not comply with the section cited above the staff did not respond to R1’s calls for assistance in a timely manner and R1's diapering needs were not met, which poses a potential health, safety and personal risk to persons in care.	8 9 10 11 12 13 14
	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: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

LIC9099 (FAS) - (06/04)

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