565802425-5-3-2024-29-AS-KHEN-D5KUVY-20240524155555

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802425
Report Date: 05/03/2024
Date Signed: 05/03/2024 01:31:04 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
04/18/2023 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20230418134450

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:	05/03/2024
		UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Rick Olds		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Licensee failed to safeguard resident's perosnal property

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit to deliver findings on the above noted allegation. LPA met with Executive Director (ED) Rick Olds and explained the reason for the visit.

On 4/18/2023, the Department received a complaint alleging at least one credit card and some cash was taken from the room of resident 1 (R1) and used without R1’s permission.

On 4/19/2023, LPA contacted the Oxnard Police Department to see if they conducted an investigation regarding the theft allegation. LPA was informed that due to the amount of money taken, it was not considered a felony and the case was therefore given a lower priority. Once the detective was able to review

(continued on page 2; 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024

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-20230418134450

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PACIFICA SENIOR LIVING OXNARD	FACILITY NUMBER: 565802425
	VISIT DATE: 05/03/2024

NARRATIVE

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(continued from page 1; 9099)

the case it was too late to secure video surveillance at the retail establishments where R1’s credit card was used.

On 4/21/2023, LPA conducted an initial complaint investigation visit and interviewed R1, three staff members, and reviewed relevant records. On 4/28/2023, LPA conducted a subsequent complaint visit and interviewed one staff member.

LPA discussed with the ED the need to safeguard resident’s belongings at the facility. There is insufficient evidence to confirm the credit card and cash were stolen from R1’s room at the facility. Therefore, the allegation the facility failed to safeguard R1’s personal property is deemed Unsubstantiated at this time.

Exit interview conducted and report issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024

LIC9099 (FAS) - (06/04)

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