565802425-3-7-2023-29-AS-JAPL-CQ5TLV-20230321145009

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802425
Report Date: 03/07/2023
Date Signed: 03/07/2023 02:22:48 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
01/13/2022 and conducted by Evaluator Angel Ascencio

COMPLAINT CONTROL NUMBER: 29-AS-20220113102423

FACILITY NAME:	PACIFICA SENIOR LIVING OXNARD		FACILITY NUMBER:	565802425
ADMINISTRATOR:	GUTIERREZ, SARA		FACILITY TYPE:	740
ADDRESS:	2211 E GONZALES RD		TELEPHONE:	(805) 983-6808
CITY:	OXNARD	STATE: CA	ZIP CODE:	93036
CAPACITY:	100	CENSUS: 49	DATE:	03/07/2023
		UNANNOUNCED	TIME BEGAN:	08:44 AM
MET WITH:	Cynthia Garcia		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Resident's oral hygiene needs were not met
Resident did not receive medical care in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angel Ascencio conducted a subsequent visit to deliver findings to the above facility. LPA Ascencio met with Business Office Manager (BOM) Cynthia Garcia at 8:55 a.m. Entrance interview conducted.

On 01/13/2022, the Department received a complaint alleging that resident’s oral hygiene were not met and resident did not receive medical care in a timely manner. On 01/20/2022, starting at 10:18 a.m., LPA Kelly Dulek conducted an interview with Executive Director (ED) Kortnie Spitznogle. Interview with ED Spitznogle revealed that Resident #1 (R1) has been on hospice for Alzheimer’s Disease since October 2021. Due to R1’s diagnosis, R1 would try to bite staff when staff attempted oral hygiene or when staff are feeding R1. Because of this behavior, R1 developed oral thrush. The hospice nurse became aware of the thrush and requested staff to continue with oral hygiene care for R1. ED Spitznogle lastly added that the staff attempted various times to provide oral care but were never successful due to R1’s behaviors.
Continued on LIC 9099 - C

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: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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-20220113102423

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: 03/07/2023

NARRATIVE

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On 03/01/2023, LPA Ascencio reviewed R1’s medical records which confirmed R1’s diagnosis and admission to hospice. Additionally, various narrative charting notes revealed that on 01/09/2022, “Resident spit out ensure this AM. Cleaned resident mouth and lips.”, and on 01/10/2022, “ Nurse from Los Robles Hospice came for a visit. Nurse stated residents’ mouth was very dry and had chocolate ensure. Resident has been combative not allowing mouth care. Nurse will call family member and ask for mineral oil for dryness.”

Later that same day, review of hospice documentation revealed that on 01/05/2022 oral care was discussed with Pacifica staff. On 01/10/2022, “Pt mouth was dry & crackling. PT won’t allow for mouth care, tries to push away” and oral mineral oil was recommended. On 01/12/2022, oral care was provided by hospice nurse. On 01/14/2022, R1’s hospice physician wrote an order to provide oral care 3x a day. R1 passed away on 01/18/2022.

Prior to 01/05/2022, there was no written documentation regarding the need for oral care in either Pacifica Senior Living documentation or Hospice Documentation. Although staff documentation stated they attempted to do their due diligence in conducting oral hygiene for R1 after 01/05/2022, documentation from hospice agency confirmed the attempts and behavior episodes of R1.

LPA Ascencio attempted various times to conduct interview with Hospice Agency worker but was unsuccessful. Interview with two (2) staff members on 03/7/2023, starting at 11:09 a.m., confirmed R1’s aggressive behaviors towards staff and other residents. Additionally, staff members added that R1 would not allow staff to help R1 with any activities of daily living, thus R1’s health would rapidly decline.

Although facility and hospice documentation stated staff attempted and provided minimal oral care for R1, there was no documentation regarding an infection or disease in R1’s mouth. Additionally, the Department received the complaint on 01/13/2022, alleging of resident's oral hygiene needs were not met, but on 01/14/2022, hospice physician wrote an order to provide oral care. Staff interviews could not validated whether oral care was provided after the written order of 01/14/2022, but the ongoing struggle of R1’s aggressive behavior to provide oral care or any ADLs was documented both by Pacifica and Hospice. Based on the information obtained, there is insufficient evidence to support the claim that the resident’s oral hygiene was not met. Thus, the allegation above is deemed Unsubstantiated at this time.

Continued on LIC 9099 - C

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220113102423

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: 03/07/2023

NARRATIVE

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Regarding the allegation of resident did not receive medical care in a timely manner. R1 was admitted to hospice care on 10/11/2021 with a terminal diagnosis of Alzheimer’s Disease. According to hospice documentation reviewed on 03/01/2023, it was revealed that R1 was being visited by hospice agency representatives 3-5 times each week for the months of November and December 2021. Because R1 was on hospice, R1 was seen frequently by a nurse, health aide, medical social worker and chaplain. Review of Pacifica’s documentation on 03/01/2023, revealed that due to R1’s advance stage of Alzheimer’s Disease, there were very frequent falls and aggressive behaviors towards staff and other residents. Documentation also revealed staff communicating with R1’s family member and hospice agency when any behaviors and fall occurred. Hospice documentation revealed that on 01/05/2022 oral care was discussed with Pacifica staff, yet hospice representatives also knew and documented about R1’s behaviors and the refusal of care. Additionally, hospice intake documentation state “Do not call 911. Call us first.”

Per a review of notes and staff interviews, there was no indication that R1 required immediate medical care outside of the conversation with the hospice nurse regarding R1’s oral care on 01/05/2022. Prior to the 01/05/2022 conversation, facility notes nor hospice notes prior to this date indicated any concerns regarding R1. As previously stated, parties were aware of R1’s refusal of care and behavioral challenges. After the conversation with the hospice nurse, staff documented efforts in tending to R1’s hygiene and oral needs. Although the complaint alleging resident did not received medical care in a timely manner was submitted to the Department on 01/13/2022, R1 was being seen by the hospice agency since date of admission on 10/11/2021 until death in 01/18/2022. Based on the information obtained in interviews and record review, there is insufficient evidence to support the claim that the resident did not receive medical care in a timely manner. Thus, the allegation above is unsubstantiated at this time.

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

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

LIC9099 (FAS) - (06/04)

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