565802425-7-7-2023-29-AS-JAPL-CUA4TN-20230731192323

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802425
Report Date: 07/07/2023
Date Signed: 07/07/2023 02:13:24 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:	07/07/2023
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Elizabeth Whittington		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Staff failed to provide adequate food service

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 failed to provide adequate food service
It was alleged that the quality of the food the facility serves to the residents is poor as it is served cold. Interviews with R1’s family member revealed that the food served to R1 was cold however it was not at the fault of the kitchen as the only food item they were able to offer at the time due to kitchen after hours was a hot dog which they heated up in R1’s room microwave. Morning food service was claimed to not be completed for R1 however interviews with staff revealed that R1 was only in the facility for less than 12 hours and was only at the facility after dinner hours up until the beginning of breakfast hours. Interviews with staff confirmed that in room breakfast service begins anywhere between 8 and 8:30 a.m. and room service is not always done before dining room service.
**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: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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: 07/07/2023

NARRATIVE

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Interviews with family claimed that they went down to the dining area to request breakfast at 8:30 a.m. at which time breakfast was just starting distribution. Information obtained from interviews with residents, staff and witnesses did not corroborate claims that food served at the facility was of poor quality nor an insufficient amount. Resident interviews communicated no concerns regarding food service and that they do receive their meals timely and in good quality. Staff confirmed that any special instructions for R1’s meal service 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’s meal service. LPA additionally observed the kitchen which had sufficient food items and were observed to be in good condition. Kitchen staff interviews revealed that there are additional food items available for residents after kitchen hours however those items offered are usually not hot items such as sandwiches and fruit, unless it is something that can be heated up easily in a microwave such as a hot dog. Based on the information obtained, there is insufficient evidence to support the claim that the facility failed to provide adequate food service. 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: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC9099 (FAS) - (06/04)

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