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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565802425
Report Date: 06/27/2024
Date Signed: 06/27/2024 02:38:46 PM

Substantiated


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
07/18/2022 and conducted by Evaluator Teresa Camara
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20220718091342
FACILITY NAME:PACIFICA SENIOR LIVING OXNARDFACILITY NUMBER:
565802425
ADMINISTRATOR:KORTNIE SPITZNOGLEFACILITY TYPE:
740
ADDRESS:2211 E GONZALES RDTELEPHONE:
(805) 983-6808
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:100CENSUS: 38DATE:
06/27/2024
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Rick OldsTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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3
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5
6
7
8
9
Facility food is of poor quality.
Facility food service is not adequate.
Facility is not following safe food handling practices.
Facility is out of stock of basic food items.
Facility staff are not wearing masks.
Facility does not have sufficient staff to meet residents' needs.
Facility staff does not respond to residents' call buttons.
INVESTIGATION FINDINGS:
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2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint visit to issue findings regarding the above noted allegations. LPA met with the current Executive Director (ED) Rick Olds and explained the reason for the visit.

Over the course of the investigation, LPA Emily Peraldi visited the facility on 7/22/2022 and 8/11/2022. During those visits, LPA Peraldi conducted interviews with staff and residents. In addition, LPA Camara investigated similar allegations on another complaint from the same time period. LPA Camara visited the facility on 7/22/2022, 3/3/2023, 9/14/2023, and 9/27/2023. LPA Camara also conducted interviews with staff and residents. During these visits, the LPAs met with the former Executive Director (ED) Kortnie Spitznogle who is the ED referred to in the remainder of this report.

(continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
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 8
Control Number 29-AS-20220718091342
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: 06/27/2024
NARRATIVE
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(continued from LIC9099)

Regarding the allegation “Facility staff are not wearing masks”: On 7/22/2022 between 10:13 a.m. and 1:20 p.m., LPAs Camara and Peraldi visited the facility together for two separate complaints with similar allegations. During the visit LPAs observed some staff wearing their masks pulled down below their noses. This timeframe was during a COVID-19 outbreak at the facility. In addition, facilities were still mandated to have staff wear masks at that time. Based on this information, the above noted allegation is deemed Substantiated at this time.

Regarding the allegations “Facility staff does not respond to residents' call buttons” and "Facility does not have sufficient staff to meet residents' needs": On 7/22/2022, LPA Camara reviewed call button history for 6/17/2022 – 7/16/2022 provided by the Business Office Manager. The call button data showed there were 42 calls that went without a response. The ED stated it could have been that the staff did not clear the call after responding. The ED did not have evidence of this, nor did she have a reason for the long response times (20 – 40+ minutes) on over 100 calls. During interviews with residents, there were concerns voiced about the call button response. One resident stated they heard one of their neighbors call out for help but nobody responded to the resident. Based on this information, the allegation is deemed Substantiated at this time.



Regarding the allegations "Facility food service is not adequate" and "Facility is not following safe food handling practices": LPAs Camara and Peraldi conducted interviews with staff and residents during their previously noted visits. LPA Camara also conducted telephone interviews with staff on 9/18/2023. Staff voiced concerns about lack of servers, especially during times when the dining room was closed during COVID outbreaks. Staff stated they had to take food to each room but there was frequently only one server. The food would get to many of the rooms cold. Some residents stated their food arrived at a good temperature while others stated they received cold food. Staff stated the temperature of the food would depend on where the residents lived in the facility because some residents received their food right away while others had to wait longer. One resident recalled receiving a plate of cold fish and chips with warm coleslaw. They also recalled not receiving lunch twice during the holidays, breakfast was frequently served late, eggs had gray streaks, and on the day the resident was interviewed, 1/4/2023, the resident did not receive breakfast at all. Staff stated some residents would ask them to heat up the food in their microwave because it arrived cold. Based on this information, these allegations are deemed Substantiated at this time.

(continued on LIC9099-C page 3)
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 8
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
07/18/2022 and conducted by Evaluator Teresa Camara
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20220718091342

FACILITY NAME:PACIFICA SENIOR LIVING OXNARDFACILITY NUMBER:
565802425
ADMINISTRATOR:KORTNIE SPITZNOGLEFACILITY TYPE:
740
ADDRESS:2211 E GONZALES RDTELEPHONE:
(805) 983-6808
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:100CENSUS: 38DATE:
06/27/2024
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Rick OldsTIME COMPLETED:
02:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not provide a safe environment for residents.
Facility staff are not adequately supervising residents.
Facility is limiting residents' visitations from family and friends.
Facility does not provide communal activities (including dining room).
INVESTIGATION FINDINGS:
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3
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5
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7
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9
10
11
12
13
Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint visit to issue findings regarding the above noted allegations. LPA met with current Executive Director (ED) Rick Olds and explained the reason for the visit.

Over the course of the investigation, LPA Emily Peraldi visited the facility on 7/22/2022 and 8/11/2022. During those visits, LPA Peraldi conducted interviews with staff and residents. In addition, LPA Camara investigated similar allegations on another complaint. LPA Camara visited the facility on 7/22/2022, 3/3/2023, 9/14/2023, and 9/27/2023. LPA Camara also conducted interviews with staff and residents.

(continued on LIC90990-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 29-AS-20220718091342
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: 06/27/2024
NARRATIVE
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32
(continued from LIC9099-A)

Regarding the allegation “Facility is limiting residents’ visitations from family and friends”: LPAs Camara and Peraldi conducted interviews with residents on the dates noted previously. None of the residents interviewed indicated staff limited their visitation with family and friends. The former Executive Director (ED) Kortnie Spitznogle stated whenever the facility had COVID positive residents she sent an email out to families informing them. She requested visitors only meet with their loved ones in their rooms and to avoid exposure to other residents. Based on interviews with residents and the ED, this allegation is deemed Unsubstantiated at this time.

Regarding the allegation “Facility does not provide communal activities (including dining room)” ED Spitznogle stated she closed the dining room and communal activities when the facility had a spike in COVID positive residents and staff. The facility provided in-room activities like crossword puzzles and other types of games. Staff took food trays to each room. She made the decision to do this before receiving instruction to do so from Ventura County Public Health (VCPH). The facility had several rounds of COVID spikes since 2020 so the ED was familiar with VCPH guidelines for closing communal activities. Based on interviews and review of COVID positive records, this allegation is deemed Unsubstantiated at this time.

Regarding the allegation "Facility staff are not adequately supervising residents": This allegation was regarding an allegation there were a couple residents who were being aggressive and urinating in the halls. During interviews conducted by LPA Peraldi with residents, none had recalled any issues with other residents acting aggressive or causing issues. One resident recalled hearing another resident in the hallway making noise one day but facility staff took care of them. Based on these interviews, this allegation is deemed Unsubstantiated at this time.

Regarding the allegation "Facility does not provide a safe environment for residents": LPA Peraldi conducted interviews with multiple residents and asked them if they felt safe at the facility. All of the residents LPA Peraldi interviewed stated they felt safe at the facility and they had no concerns regarding that issue. Based on these interviews, this allegation is deemed Unsubstantiated at this time.

No deficiencies observed regarding these allegations. Exit interview conducted and report issued.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 8
Control Number 29-AS-20220718091342
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: 06/27/2024
NARRATIVE
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(continued from LIC9099-C, page 2)

Regarding the allegations "Facility food is of poor quality" and "Facility is out of stock of basic food items": LPAs Camara and Peraldi conducted interviews with staff and residents during their previously noted visits. LPA Camara also conducted telephone interviews with staff on 9/18/2023. Staff voiced concerns about the quality of food being served. They had concerns that the type of food being served was inappropriate for the population. The Food Services Director at the time prepared menus with a lot of starchy foods, burgers, spicy foods, etc. Staff stated they did not serve enough fresh fruits and vegetables. Residents had similar concerns and many stated there were far too many starchy items and not enough fresh fruits and vegetables. Staff also had concerns about running out of basic food items such as oil, fruits, vegetables, items to make things that were on the menu like soup. Staff stated they had to pay out of their own pocket for food staples to get them by until the next food order arrived. Staff stated they ran out of these items due to poor ordering by the former Food Services Director. Residents recalled being told the facility was out of things like coffee and juices. One resident stated they should be on a special diet but they were not offered choices for a diabetic diet and was served a lot of starchy food. Based on these interviews, these allegations are deemed Substantiated at this time.

Regarding the allegation "Facility does not have sufficient staff to meet residents' needs": LPAs Camara and Peraldi conducted interviews with staff and residents during their previously noted visits. LPA Camara also conducted telephone interviews with staff on 9/18/2023. Staff voiced concerns about being understaffed. They stated the medication technicians frequently had to act as caregivers which led to some residents receiving their medications late. Another staff stated that during periods of COVID outbreaks they would frequently only have one server to deliver trays of food to all residents. Staff recalled when delivering food to the rooms of residents who had COVID, they were told to just leave the trays outside the room but that staff did not believe the residents were aware the food was there and would see the food just sit there uneaten. One resident recalled when they had COVID their food tray was left on the COVID "box" outside their room but they did not know the food was there. Based on these interviews, the allegation is deemed Substantiated at this time.

Per the California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiencies are cited: (Refer to LIC 9099-D). Exit interview conducted. Report and appeal rights were issued.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 29-AS-20220718091342
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/11/2024
Section Cited
CCR
87555(a)
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87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents... All food shall be selected, stored, prepared and served in a safe and healthful manner.
This requirement is not met as evidence by:
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Licensee will provide a written plan on how they will ensure residents are served food at proper temperatures, offering fresh produce, and ensuring they do not run out of staple foods.
Submit to CCL on or before 7/11/2024.
8
9
10
11
12
13
14
Based on resident and staff interviews, the licensee did not comply with the section cited above, too many starches and not enough fresh produce, running out of food items, hot food served cold, which poses a potential health, safety, and personal risk to persons in care.
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Type B
07/11/2024
Section Cited
CCR
87555(b)(18)
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87555 General Food Service Requirements (b) The following food service requirements shall apply:(18) Sufficient food service personnel shall be employed, trained and their working hours scheduled to meet the needs of residents.
This requirement is not met as evidence by:
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Licensee will submit a written plan on how they will handle meal service in the future in the event all residents must be served meals in their rooms.
Submit to CCL on or before 7/11/2024.
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9
10
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12
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14
Based on resident and staff interviews, the licensee did not comply with the section cited above, due to late or no meal service while meals were served in residents' rooms due to COVID outbreaks, which poses a potential health, safety, and personal risk to persons in care.
8
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10
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13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 8
Control Number 29-AS-20220718091342
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/11/2024
Section Cited
CCR
87468.1(a)(2)
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3
4
5
6
7
87468.1(a)(2) Personal Rights of Residents in All Facilities ...To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee will submit a writtne plan on how they will ensure staff compliance with wearing facemasks during outbreaks at the facility.
Submit to CCL on or before 7/11/2024.
8
9
10
11
12
13
14
Based on LPAs' observations, the licensee did not comply with the section cited above, as staff were not properly wearing face masks in the facility, which poses a potential health, safety, and personal risk to persons in care.
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Type B
07/11/2024
Section Cited
CCR
87468.2(a)(4)
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7
87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities... To care, individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by:
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3
4
5
6
7
Licensee will submit a written plan on the expected response time and how they will ensure staff respond to call buttons within the expected response time.
Submit to CCL by 7/11/2024.
8
9
10
11
12
13
14
Based on resident and staff interviews and record review of alert response times, some responses were not completed in a timely manner and other calls went unanswered, which poses a potential health, safety, and personal risk to persons in care.
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9
10
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12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 29-AS-20220718091342
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/11/2024
Section Cited
CCR
87411(a)
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2
3
4
5
6
7
87411 Personnel Requirements General
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will submit a written plan on how they will ensure staffing in all aspects of the facility is at sufficient levels to meet the needs of residents.
Submit to CCL by 7/11/2024.
8
9
10
11
12
13
14
Based on resident and staff interviews, the licensee did not comply with the section cited above, late/no meal service when served in room, late/no response to call buttons due to lack of staff, which poses a potential health, safety, and personal risk to persons in care.
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9
10
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14
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5
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7
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7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
LIC9099 (FAS) - (06/04)
Page: 8 of 8