565802425-7-10-2023-29-AS-JAPL-CUA4TM-20230731192322

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802425
Report Date: 07/10/2023
Date Signed: 07/10/2023 03:57:32 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
04/27/2023 and conducted by Evaluator Elsie Campos

COMPLAINT CONTROL NUMBER: 29-AS-20230427100226

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:	07/10/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Executive Director Elizabeth Whittington		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Staff neglected resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elsie Campos arrived unannounced to conduct a subsequent complaint visit. The LPA met with Executive Director Elizabeth Whittington and explained the reason for the visit.

Allegation: Staff neglected resident while in care
It was alleged that staff were to check on Resident #1 (R1) every two hours, along with daily bath and dressing assistance. It was further alleged that no one came to check on R1 from 3:00 p.m. until 10:00 p.m. on the day R1 arrived at the facility. It was alleged that staff were seen and heard in the hall laughing, talking about needing a nap, but allegedly never came to R1’s room or came to check on R1 during the night. Interviews with staff did not deny claims that they talk in the hallways however denied that personal interactions interfere with resident care. Interviews with staff further revealed that R1 was only in the facility for less than12 hours and was only at the facility around dinner hours up until the beginning of breakfast hours.
**Continued on LIC 9099-C**

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

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-20230427100226

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: 07/10/2023

NARRATIVE

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It was further mentioned that because R1 was settling in and was accompanied by family staff do not custom not to interfere unless requested by family to come in. Staff were not briefed to check on R1 throughout the first night as R1 had just arrived at the facility and was getting comfortable with family. Interviews with staff confirmed staff are normally notified of new residents before starting a shift so they can accommodate any of their needs. Information obtained from interviews with residents, staff and witnesses did not corroborate claims that staff neglect residents while in care. Resident interviews communicated no concerns regarding care or not having their needs met and indicated that staff are responsive to their needs. Staff confirmed that any special instructions for R1 were in place and that R1 was only in the facility for a short period of time which may have interfered with the facilities ability to follow through on R1 needs and services plan on the day of arrival. Based on the information obtained, there is insufficient evidence to support the claim that the facility staff neglected resident while in care. The allegation is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

LIC9099 (FAS) - (06/04)

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