565802425-5-31-2023-29-AS-JAPL-CUA4TP-20230731192324

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802425
Report Date: 05/31/2023
Date Signed: 05/31/2023 02:02:23 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: 47	DATE:	05/31/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Elizabeth Whittington		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Facility is unclean
Staff failed to provide a comfortable environment for residents
Staff failed to issue a refund

INVESTIGATION FINDINGS:

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

Today, the LPAs toured the facility, conducted four (4) staff interviews from 10:00 a.m. - 11:15 a.m., and seven (7) resident interviews from 12:00 p.m. – 1:15 p.m. The LPA’s also interviewed two (2) resident responsible parties at 10:40 a.m. and 11:16 a.m. In addition, the LPAs reviewed records pertinent to the investigation.

CONT 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: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

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 4

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: 05/31/2023

NARRATIVE

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Allegation: Facility is unclean
It is alleged that upon move in, Resident #1's (R1) room was unclean. It was further alleged that R1’s cupboards and drawers were not cleaned out, and R1’s refrigerator was not cleaned out. Interviews with care staff and housekeeping staff supported claims that upon notification of a new resident move in, rooms are appropriately cleaned to prepare for the new admit. Staff whom were present in the room denied claims that R1’s room was unclean, yet admitted that there were items found in R1’s drawers. However, staff contacted housekeeping, whom immediately responded and ensured that all drawers were fully cleaned out. Information obtained from resident interviews denied claims that rooms were unclean, and it was noted that housekeeping staff are responsive in ensuring that rooms were tended to on a weekly, or as-needed basis. The LPA toured a random selection of resident rooms in the assisted living and memory care unit and toured the common spaces and observed areas to be clean. During the visits conducted on 5/19/2023 and 5/31/2023, the LPA observed housekeeping staff actively cleaning resident rooms and facility common areas. Based on the information obtained, there is insufficient evidence to support the claim that the facility is unclean. This allegation is deemed Unsubstantiated at this time.

Allegation: Staff failed to provide a comfortable environment for residents
It is alleged that staff were overheard to be speaking inappropriately amongst each other in common spaces (resident hallways). Staff allegedly were laughing and talking about weekend plans, and not tending to resident care needs. Interviews with care staff supported claims that they do have casual conversations amongst each other. Interviews with residents denied claims that they have overheard staff having inappropriate conversations or felt uncomfortable. Information from staff interviews reveled that staff have casual check ins with each other but refrain from conversations being inappropriate in nature. During the visits conducted on 5/19/2023 and 5/31/2023, the LPA observed staff speaking amongst each other in facility common areas however did not observe any inappropriate conversations. Residents also denied concerns with staff's ability to respond to care needs timely. Based on the information obtained, there is insufficient evidence to support the claim that the Staff failed to provide a comfortable environment for residents.This allegation is deemed Unsubstantiated at this time.

CONT 9099-C

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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: 05/31/2023

NARRATIVE

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Allegation: Staff failed to issue a refund
It was alleged that staff failed to issue a refund. Interviews and records review confirmed that R1 was admitted on 3/4/2023, and subsequently moved out on 3/5/2023. Staff claimed that they had submitted a claim to corporate for a refund of the community fee but could not speak to the reason as to why it took a long time for R1’s responsible party to receive a refund. Records indicated that a check was issued to R1’s responsible party on 05/18/2023 in the amount of $500. Staff interviews confirmed that if an assessment had been completed by the care team, R1’s responsible party would have only received a refund in the amount of $500. Although R1’s responsible party claimed that they were unaware of the reason as to why they did not receive the full refund, records review confirmed that R1’s responsible party had signed a ‘Refundable Community Fee’ agreement on 02/17/2023, which indicated that the community fee of $1000 was to cover the costs associated with processing paperwork, completing an assessment, and resident orientation. The agreement also indicated that after an assessment is completed, the first $500 of the community fee becomes non-refundable. An interview with R1’s responsible party confirmed that they received a refund in the amount of $500. Staff provided the LPA with a copy of the appraisal dated 3/2/2023. In addition, although R1’s responsible party signed the Refundable Community Fee agreement, which states the terms of receiving a refund for the preadmission fees, it is alleged that the document was not explained in detail.

Due to the conflicting information received from all parties involved during interviews and records review, there is insufficient evidence to support the allegation. The above allegation is Unsubstantiated at this time.
No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

LIC9099 (FAS) - (06/04)

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