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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802425
Report Date: 02/22/2023
Date Signed: 02/22/2023 03:34:19 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 Angel Ascencio
COMPLAINT CONTROL NUMBER: 29-AS-20220425095729
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: 47DATE:
02/22/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Cynthia GarciaTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facilities food service is inadequate
INVESTIGATION FINDINGS:
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This report was originally issued on 01/31/2023. The report was amened to change the finding based on additional information gathered on 02/22/2023.

Licensing Program Analyst (LPA) Angel Ascencio, Ashley Morgan and Esther Cortez conducted a subsequent complaint visit to deliver findings to the above facility. LPA's met with Executive Director (ED) Kortnie Spitznogle at 9:30 a.m. Entrance interview conducted.

The Woodland Hills North Regional Office (RO) received a complaint on 04/25/2022 regarding facilities food service is inadequate. On 04/25/2022, at 12:33 p.m. and around 4:37 p.m., LPA observed dining room staff with trays of food delivering to various residents within the facility. That same day, starting at 1:48 p.m., interview with Resident #1 (R1) revealed that the food arrived on time and was not cold. R1 added that there are days that the food arrives cold, other days, the food comes back warm, never hot. On 01/23/2023, starting at 12:30 p.m., interview with six (6) residents confirmed that the food temperature and delivery of food various daily. 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: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023
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 3
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: 02/22/2023
NARRATIVE
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Further interviews with residents also revealed the process of delivery of meals to rooms. Most of the time, the dinning room staff begin delivery of food at 8:00 a.m., starting with the 1st floor. Because they are delivering to 30 + residents, by the time dining staff reach the 3rd floor, the food is cold and arrives late. Other occasions, the dinning staff begin with the 3rd floor and work their way down to the 1st floor. Temperature and delivery times vary daily with it starting at 8:00 a.m.- 9:30 a.m. for breakfast, 12:00 p.m. - 1:00 p.m. for lunch and 5:00 p.m. - 6:00 p.m. for dinner. Interviews with staff six (6) staff members on 10/13/2022, 01/04/2023, and 01/23/2023 revealed that some staff claim they do their due diligence in ensuring that the residents get their meals on time. Staff interviews also indicated that due to an inadequate supply of perishable and nonperishable foods, meals are delayed on different days.

Interview with R2 on 10/13/2022, starting at 1:20 p.m., on 01/03/2022, starting at 1:23 p.m. and on 01/23/2023, starting at 12:10 p.m., revealed that there have been various times that food was not delivered on time. R2 added that on 01/22/2023, R2 and all the residents at the facility received their breakfast one (1) hour after the allotted time of 8:00 – 9:30 a.m. Two (2) resident interviews on 01/24/2023 with LPA Ashley Morgan confirmed what R2 had stated regarding breakfast arriving late. During LPA Morgan's visit, LPA observed food being delivered late at 1:30 p.m. to a resident room.

Interviews with eight (8) residents on 10/13/2022, 01/04/2023, 01/23/2023, 02/22/2023 revealed that although the facility does provide meals, the food being served is not of best quality, and the staff often forgets utensils and condiments. Additionally, when the food is delivered to the resident’s room, most of the time, the meals arrive late and cold. Although residents had mixed feeling about the temperature and delivery of food, staff also stated they try to do their due diligence in ensuring food service is adequate.

Based on information obtained in interviews, there is sufficient evidence to support the claim that the facility food service is inadequate.

A similar complaint was substantiated on 2/22/2023.

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

DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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: 02/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2023
Section Cited
CCR
87468.2(a)(4)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities. (a)(4) Residents … shall have ... the following ... rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency ...
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BOM stated they will create a plan for food services that maintains compliance with regualtions and personal rights. BOM will deliver plan to LPA by 2/27/23.
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Based on interviews and evidence gathered throughout the investigation, the licensee did not comply with the section cited above as various residents stated that food service is inadequate which poses an potential health, safety and personal rights risk to residents on 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: 02/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3