565802425-10-30-2023-29-AS-DPEA-CX5RGZ-20231031130135

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802425
Report Date: 10/30/2023
Date Signed: 10/30/2023 03:12:39 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 Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20230427152417

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: 41	DATE:	10/30/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Karen Enciso		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff not providing adequate food service.
Resident left in soiled diapers for extended amount of time.
Resident needs not being met.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent visit to the facility to issue findings for the above allegations. The initial visit was conducted on 04/28/2023 by LPA’s T. Camara and K. Lopez a subsequent visit was conducted on 08/01/2023 by LPA M. Arroyo. During today's visit, LPA met with Interim Executive Director, Karen Enciso, and the reason for the visit was explained. Entrance interview.

During the initial visit on 04/28/2023, LPA’s Camara and Lopez toured the kitchen at 10:21 a.m., toured memory care at 10:44 a.m., and reviewed and obtained copies of pertinent documents at 11:05 a.m. On 08/01/2023, LPA Arroyo conducted a plant tour at 12:56 p.m., toured memory care at 1:00 p.m., toured the kitchen/food area and dining room at 1:15 p.m., conducted interviews with the ED, two staff members, and four residents between 1:02 p.m. and 2:46 p.m., and conducted a resident file review at 3:40 p.m. and obtained copies of pertinent documents relevant to the investigation. Additionally, the LPA conducted telephonic interviews with family members on 09/29/2023 at 11:20 a.m., and 11:55 a.m., and 12:20 p.m.
(Report Continued on LIC 9099C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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-20230427152417

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: 10/30/2023

NARRATIVE

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(Report Continued from LIC 9099...)

It was alleged that staff are not providing adequate food service. It was reported that Resident #1 (R1) and others have been under fed resulting in weight loss. During the visit on 08/01/2023, the LPA observed the kitchen, food supply, monthly menu posted by the kitchen, copies of daily menu by the front desk, and random residents having lunch. The facility had a variety and adequate supply of perishable and non-perishable foods including eggs, meats, breads, canned goods, fresh fruit, fresh vegetables, and milk. Interviews conducted with residents revealed the food is good and stated snacks are passed every day around the same time. The snacks vary by days as sometimes they will get crackers, cheese, or ice cream. Interviews conducted with family members revealed that they get copies of the monthly menus from the front desk when they visit to know what the resident will be having throughout the month. Additionally, family members stated observing residents asking and receiving snacks in between meals while visiting. Furthermore, residents and family members reported having no concerns with the facility. Based on LPA observation and interviews conducted with the staff, residents, and family members, there is insufficient evidence to support the allegation of “staff are not providing adequate food service”. Therefore, this allegation is deemed Unsubstantiated at this time.

It was also alleged that residents are left in soiled diapers for extended amount of time. It was reported that residents are being left in soiled diapers and residents’ beds have soiled linens. Additionally, urine stains were seen in R1’s bedsheets and R1 had to be changed several times due to R1 being wet. Information obtained and reviewed revealed that about 80% of residents in memory care are incontinent and wear diapers. Interviews conducted with residents revealed that staff are often checking on the residents throughout the day. Staff reported checking on the residents at least every two (2) hours and changing them when needed. Additionally, staff stated they have not had any family members report the residents being dirty or wet while visiting. Interviews conducted with family members revealed they often visit the residents and have not observed them being in soiled diapers. Family members stated the staff is good at changing the residents and keeping them clean. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “residents are left in soiled diapers for extended amount of time”. Therefore, this allegation is being deemed Unsubstantiated at this time.

(Report Continued on LIC 9099C...)

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230427152417

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: 10/30/2023

NARRATIVE

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(Report Continued from LIC 9099C...)

It was further alleged that residents’ needs are not being met. It was reported that R1 has not been shaved and bathed for days at a time including brushing their teeth and laundry has not been completed for weeks. Additionally, the facility was to have a podiatrist and hairdresser come to the facility to service residents. Information obtained and reviewed revealed that residents have scheduled showers; however, residents also have the right to refuse any type of service. The end of shift report indicates how the residents interact each day. Additionally, on the narrative charting staff reported when R1 was refusing any service such as bathing and/or shaving and staff reported R1 had refused showers several times while living at the facility. Additional interviews revealed that residents will at times refuse their showers and staff will attempt to try again later the same day if not the following day. Additionally, housekeeping is done once a week for all residents in both assisted living and memory care. Per R1’s Admissions Agreement dated 01/26/2023 it states on page 7 section B that ‘personal laundry is available for an additional charge’ and on page 24 under Appendix A R1’s Power of Attorney (POA) did not indicate that they wanted additional personal laundry services added to their basic services. In addition, record review revealed that the facility places a sign-in sheet for both assisted living and memory care residents to sign up to see the Podiatrist which is scheduled to come to the facility every six (6) weeks. These sign-in sheets are available by the front desk for family members to sign up the residents from both assisted living and memory care. Furthermore, interviews conducted with residents and family members revealed they feel the facility is meeting their needs and had no concerns. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “residents needs are not being met”. Therefore, this allegation is being deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued at this time. A copy of the report was provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC9099 (FAS) - (06/04)

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