565802425-8-21-2024-29-AS-KHEN-DACVR3-20241024163915

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565802425
Report Date: 08/21/2024
Date Signed: 08/21/2024 04:22:13 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
09/18/2023 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20230918110909

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: 36	DATE:	08/21/2024
		UNANNOUNCED	TIME BEGAN:	02:17 PM
MET WITH:	Rick Olds		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Administrator is not at the facility a sufficient number of hours to adequately manage facility operations.
Staff not assisting resident in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit regarding the above noted allegations. LPA met with executive director/administrator (ED) Rick Olds and explained the reason for the visit.

Regarding the allegation: Administrator is not at the facility a sufficient number of hours to adequately manage facility operations.
LPAs had conducted prior investigation visits to the facility on 9/18/2023, 9/25/2023, 12/12/2023, and 3/8/2024. On 9/18/2023, LPA Kelly Dulek found the facility was being run by the Maintenance Director who had not been fingerprint cleared to work at the facility. The Maintenance Director stated he was the only manager left at the facility. The Executive Director Elizabeth Whittington no longer worked there and

(continued on LIC9099-C)

Substantiated

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: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

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-20230918110909

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: 08/21/2024

NARRATIVE

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(continued from LIC9099)

corporate representatives who were supposed to be in charge of running the facility until a new executive director was hired had not shown up in several days. The Maintenance Director was struggling to keep all of the shifts fully staffed as staff were calling in sick or just not showing up. The Maintenance Director was even providing care to residents himself even though he had not been trained in caregiving. Based on interviews with staff this allegation is deemed Substantiated at this time.

Regarding the allegation: Staff not assisting resident in a timely manner.
LPAs had conducted prior investigation visits to the facility on 9/18/2023, 9/25/2023, 12/12/2023, and 3/8/2024. Based on interviews with staff, residents were complaining to them about long wait times to receive assistance from staff. They asked to speak with management regarding the wait times but nobody was available. Staff stated due to lack of staffing, residents were not being assisted in a timely manner. Interviews with residents indicated the same issue. Based on interviews, this allegation is deemed Substantiated at this time. The facility was already cited on this complaint for lack of staffing on 3/08/2024.

The following deficiencies were observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties.
Exit interview conducted. A copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230918110909

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: 08/21/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/21/2024 Section Cited CCR 87405(a)	1 2 3 4 5 6 7	87405 Administrator - Qualifications and Duties. (a) All facilities shall have a qualified and currently certified administrator...The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section.	1 2 3 4 5 6 7	The current administrator is scheduled at the facility Monday through Friday from 9:00 a.m. to 6:00 p.m. and on-call for emergencies which appears to be a sufficient number of hours to operate the facility.
	8 9 10 11 12 13 14	Based on interviews with staff, the licensee did not comply with the above cited section, as there was no qualified administrator running the facility for several days during a time of severe staffing shortage, which posed a potential health and safety risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 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 Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

LIC9099 (FAS) - (06/04)

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