565802425-7-11-2023-29-AS-JAPL-CU2S5S-20230724133449

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802425
Report Date: 07/11/2023
Date Signed: 07/11/2023 06:58:32 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
04/20/2022 and conducted by Evaluator Angel Ascencio

COMPLAINT CONTROL NUMBER: 29-AS-20220420082532

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: 44	DATE:	07/11/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Elizabeth Whittington		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Staff not communicating with authorized representative in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angel Ascencio arrived at the above facility to deliver findings. LPA Ascencio met with Executive Director (ED) Elizabeth Whittington at 09:30 a.m. Entrance interview conducted.
On 04/20/2022, the Department received a complaint alleging that staff is not communicating with authorized representative in a timely manner. Interview with ED Kortnie Spitznogle, on 04/25/2022 starting at 10:10 a.m. revealed that R1’s family member calls the facility various times of the week and expect answers immediately. There have been a number of occasions that R1’s family member curses and yell at facility staff because R1’s family member cannot reach the ED. ED Spitznogle added that they attempt to return the call in a timely manner but because of the needs of the facility, ED Spitznogle returns the call at a later time, 2-5 days after the initial call. Interview with R1’s Family Member on 05/04/2022 revealed that ED Kortnie Spitznogle does not return calls or does not reply to emails timely.
Continued on LIC- 9099 C Page 1

Substantiated

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: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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-20220420082532

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: 07/11/2023

NARRATIVE

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Additionally, R1’s family member indicated that it would take days or even weeks for the ED to return the call, despite R1’s family member calling daily. At one point, R1’s family member mailed a certified letter to ED Spitznogle requesting additional information regarding rent increase and packages. R1’s family member stated after a certified mail was delivered on 04/12/2022, they received an email on 04/26/2022 by ED Spitznogle. Email conversation, on 07/11/2022, between R1’s family member and ED Spitznogle indicated that ED Spitznogle was reaching out to R1’s family member due to ED Spitznogle receiving a certified letter, while R1’s family member indicated that the letter was delivered on 04/12/2022 and it took more over a week for ED Spitznogle to get back to them. Fifteen (15) days would pass before the email was sent by ED Spitznogle. Additionally, another email was observed, dated on 04/29/2022 from R1’s family member requesting a call from ED Spitznogle. A continuation of that email revealed that on 05/03/2022, a telephone call was conducted between ED Spitznogle and R1’s family member. Four (4) days after requesting to chat with the ED.

A review of the California Code of Regulations, Title 22, 87468.1 Personal Rights of Residents in All Facilities, indicates that: (a) Residents in all residential care facilities for the elderly shall have all the following personal rights: (9) To have communications to the licensee from their representatives answered promptly and appropriately. Promptly, meaning immediately or without delay.

Even though R1’s family member requested to speak to the ED on various occasions, ED Spitznogle returned the family members request by a call or email. However, based on the Title 22 regulation, ED Spitznogle did not promptly and appropriately communicate with the R1’s family member as various days passed before a response was generated by ED Spitznogle. Thus, the allegations, staff is not communicating with authorized representative in a timely manner is deemed substantiated at this time.

1 Citation was issued today. Per the California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiencies are cited: (Refer to LIC 9099-D).

Exit interview conducted and a copy of the report and appeal rights were issued to ED Whittington.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC9099 (FAS) - (06/04)

Page: 2 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
04/20/2022 and conducted by Evaluator Angel Ascencio

COMPLAINT CONTROL NUMBER: 29-AS-20220420082532

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: 44	DATE:	07/11/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Elizabeth Whittington		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Staff not providing adequate care to resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angel Ascencio arrived at the above facility to deliver findings. LPA Ascencio met with Executive Director (ED) Elizabeth Whittington at 09:30 a.m. Entrance interview conducted.

On 04/20/2022, the Department received a complaint alleging that staff not providing adequate care to resident in care. Interview with R1’s Family Member on 05/04/2022 revealed that R1 has not had their fingernails and toenails trimmed in a few months. R1 has signed up for the mobile podiatrist to service R1 when in need at the facility but it has been a long time.

On 06/29/2023, a file review was conducted revealing that R1 was on home health services on 05/26/2020, hospice services beginning on 05/21/2021 and signed consent forms for a mobile podiatrist on 06/25/2021.

Continued on LIC 9099 - C Page 1

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: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 29-AS-20220420082532

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: 07/11/2023

NARRATIVE

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File review also revealed no documentation within home health, hospice and facility notes indicating the necessity of podiatry services. Interview with a podiatry Health Service Coordinator, on 06/29/2023, starting at 1:54 p.m., revealed that R1 was seen by the podiatrist on two (2) separate occasions: once (1) on 03/11/2021 and another on 06/05/2022. That same day, interview with a hospice representative, at 2:15 p.m., revealed that although a resident can be on hospice services, podiatry care is a service not offered under hospice care. If the resident requires podiatry services, the hospice agency will reach out to a podiatrist. Also, that same day, interview with Staff #1 (S1), starting at 2:35 p.m. confirmed what hospice representative stated. In addition, S1 added that if a resident is not on hospice services, Pacifica will reach out to a podiatrist to come out and provide services.

On 07/11/2023, a review of Pacifica’s Admission Agreement form indicated that on page four (4), section J. Observation and Consultation: The staff at the Community will observe your health status to identity your dietary, social, and health care needs and will provide you with the consultations regarding social and health-related issues. The community will notify family, responsible parties and other appropriate persons and/or agencies of your significant needs. Additionally, Section II. Personal Assistance and Care, on page six (6) indicated that: We will also assist you, as needed, with the scheduling of medical and dental appointments and with accessing community resources and transferring to outside facilities, as needed and prescribed by your primary physician.

Although there was a significant time gap between podiatry services for R1, 03/22/2021 and 06/05/2022, review of home health, hospice and facility documentation did not indicate that R1 needed podiatry services. Based on information gathered, there is insufficient evidence to support the claim that staff are not providing adequate care to resident in care. The allegation is deemed unsubstantiated at this time.

LPA Ascencio spoke with ED Whittington regarding the Admission Agreement policies and reiterated the importance to observe a resident’s health status needs and provide consultation on those issues and notifying the appropriate persons or agency.

Exit interview conducted and a copy of the report was issued to ED.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 29-AS-20220420082532

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: 07/11/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/21/2023 Section Cited CCR 87468.1(a)(9)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(9) To have communications to the licensee from their representatives answered promptly and appropriately.	1 2 3 4 5 6 7	ED will design a plan to effectively communicate with family members and the time frame of that communication. Plan will be send to CCL by 07/21/2023.
	8 9 10 11 12 13 14	This requirement is not met as evidence by: Based on interviews and documentation the licensee did not comply with the section cited above as ED Spitznogle did not communicate with R1's family member promptly with poses a potential health, safety and personal rigths violation to person 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: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC9099 (FAS) - (06/04)

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