567609954-10-20-2023-29-AS-KLOZ-CX5UPL-20231031154543

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 567609954
Report Date: 10/20/2023
Date Signed: 10/20/2023 05:12:18 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
10/03/2023 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20231003143814

FACILITY NAME:	ARTESIAN OF OJAI, THE		FACILITY NUMBER:	567609954
ADMINISTRATOR:	AMBER L WINTERSTEIN		FACILITY TYPE:	740
ADDRESS:	203 E EL ROBLAR DRIVE		TELEPHONE:	(805) 798-9305
CITY:	OJAI	STATE: CA	ZIP CODE:	93023
CAPACITY:	72	CENSUS: 39	DATE:	10/20/2023
		UNANNOUNCED	TIME BEGAN:	09:28 AM
MET WITH:	Amber Winterstein		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Facility refuses to provide resident records and incident reports to residents responsible party (RP)
Resident incident reports are not being reported to RP and Licensing
Staff is not trained properly in dementia resident care and transfers

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Esther Cortez conducted a subsequent complaint visit to the facility at 09:00 a.m. The LPA was greeted by staff and the reason for the visit was explained. Administrator Amber Winterstein arrived shortly after.

Today, the LPA conducted one (1) resident, four (4) staff interviews, interviewed the administrator throughout the visit, and obtained pertinent copies between 9:00 a.m. and 5:00 p.m.

On the allegation that Facility refuses to provide resident records and incident reports to resident’s responsible party, it is the reporting party’s concern that the responsible party for one resident (R1) requested copies of incident reports, information on resident falls, physicians report from the hospital and did not receive any documents.
Report will continue on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

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-20231003143814

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: ARTESIAN OF OJAI, THE	FACILITY NUMBER: 567609954
	VISIT DATE: 10/20/2023

NARRATIVE

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To investigate the allegation, the LPA conducted staff interviews, and obtained pertinent documents during both initial and subsequent visits. Staff interviews revealed that there have been occasions when R1’s responsible party has requested resident records and/or incident reports and was denied the records. Administrator Amber admitted that the previous Administrator, Michael O’Neil, would not provide records unless they were subpoenaed. In addition, record review revealed that Health Services Director (HSD) stated “Incidents are written on internal documents, which we do not provide. Internal documents are for the Artesian staff only” to R1’s responsible party via email. Lastly, HSD admitted that they have denied documents to R1’s responsible party due to being instructed to do so by previous administrator and was unaware what documents could be provided to a resident’s responsible party. Based on interviews and record review, there is sufficient evidence to support the allegation that Facility refuses to provide resident records and incident reports to resident’s responsible party. The allegation is deemed Substantiated at this time.

It was alleged that Resident incident reports are not being reported to RP and Licensing. To investigate the allegation, the LPA conducted staff interviews, and obtained pertinent documents during both initial and subsequent visits. Staff interviews revealed that when there are resident incidents, staff will either document the incident as observations or complete an Incident report depending on the level of the incident on the facilities Alis application. If the incident is something that needs to be communicated between staff such as a resident not eating all their dinner, it will be documented as an observation. However, if an incident is major such as a fall, a written report will be documented. Responsible parties should be notified of all resident incidents, and licensing should be notified via an Unusual/Incident Report (LIC624). On 10/10/23, the LPA conducted a file review of all LIC624s reported to the department for the year of 2023 and did not find any LIC624 submitted for R1. However, document review revealed that R1 has had seven (7) separate incidents within 2023. Management gave conflicting answers as to who was responsible to submit LIC624 to licensing. Based on interviews and record review, there is sufficient evidence to support the allegation that Resident incident reports are not being reported to RP and Licensing. The allegation is deemed Substantiated at this time.

Report will continue on LIC9099-C.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20231003143814

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: ARTESIAN OF OJAI, THE	FACILITY NUMBER: 567609954
	VISIT DATE: 10/20/2023

NARRATIVE

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On the allegation that Staff is not trained properly in dementia resident care and transfers, it is the reporting party’s concern that one resident (R1) had a fall during a transfer due to staff not being trained properly in resident care and transfers. To investigate the allegation, the LPA conducted a staff training record review for four (4) random elected staff. Record reviewed revealed that staff does not have adequate dementia training. The following was noted during Relias training record review: one out four staff (S1) did not have any dementia training, one out of four staff (S2) had .75 hours of dementia training, and two out of four staff had 1.75 hours of dementia training. Based on record review, there is sufficient evidence to support the allegation that Staff is not trained properly in dementia resident care and transfers. The allegation is deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations (CCR), the following deficiencies are cited (refer to LIC9099-D).

Exit interview was conducted with the Administrator. A copy of the report and Appeal Rights were issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20231003143814

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: ARTESIAN OF OJAI, THE	FACILITY NUMBER: 567609954
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/20/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/20/2023 Section Cited HSC 1569.625(b)(2)	1 2 3 4 5 6 7	569.625( b)(2) Staff training; legislative findings.In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training This training shall be administered on the job..This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The Administrator agreed to the following: 1. Submit a Plan of Action, detailing how the facility will maintain compliance with the regulation by 10/27/23 2. Audit staff files and ensure all staff have all initial and annual dementia training. Submit completion by 11/20/2023.
	8 9 10 11 12 13 14	Based on record review, the licensee did not comply with the section cited above as four staff did not have adequate dementiia training which poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
Type B 10/27/2023 Section Cited CCR 87506(c)(1)	1 2 3 4 5 6 7	87506(c)(1) ...The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. This requirement was not met as evidence by:	1 2 3 4 5 6 7	Administrator agreed to submit a statement of understanding of regulation 87506 and will make a plan on how to follow up on record requests in a timely manner and submit to CCL by 10/27/203
	8 9 10 11 12 13 14	Based on interviews and document review, the licensee did not comply with the section cited above when the facility did not make records available to R1's representative, which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 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.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20231003143814

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: ARTESIAN OF OJAI, THE	FACILITY NUMBER: 567609954
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/20/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/27/2023 Section Cited CCR 87211(a)(1)(D)	1 2 3 4 5 6 7	87211(a)(1)(D) Reporting Requirements. A written report shall be submitted … within seven days of the occurrence of any of the events specified ... (D) Any incident which threatens the welfare, safety or health of any resident ... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The licensee has agreed to do the following: 1. Submit incident reports for R1’s incidents and/or hospitalizations for the record. Review the report for exact dates. Submit to CCL no later than 10/27/2022.2.Administrator agreed to submit a statement of understanding of regulation 87211(a)(1)(D)
	8 9 10 11 12 13 14	Based on record review, the licensee did not comply with the section cited above, as reports were not submitted for all of R1’s incidents, which poses a potential health and safety risk for residents 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.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 7

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
10/03/2023 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20231003143814

FACILITY NAME:	ARTESIAN OF OJAI, THE		FACILITY NUMBER:	567609954
ADMINISTRATOR:	AMBER L WINTERSTEIN		FACILITY TYPE:	740
ADDRESS:	203 E EL ROBLAR DRIVE		TELEPHONE:	(805) 798-9305
CITY:	OJAI	STATE: CA	ZIP CODE:	93023
CAPACITY:	72	CENSUS: 39	DATE:	10/20/2023
		UNANNOUNCED	TIME BEGAN:	09:28 AM
MET WITH:	Amber Winterstein		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Insufficent staffing to handle residents needs and medication managment
Staff does not have qualifications to be Administrator

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 6 of 7

Control Number 29-AS-20231003143814

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: ARTESIAN OF OJAI, THE	FACILITY NUMBER: 567609954
	VISIT DATE: 10/20/2023

NARRATIVE

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On the allegation that there is Insufficient staffing to handle residents needs and medication management, it is the reporting party’s concern that several Medical Technicians have quit, and the facility only has three (3) MT to take care of all 4 buildings. To investigate the allegation, the LPA conducted staff interviews, resident interviews, observations, and record review. The facility has two memory care units (Matilija and Topa Topa), and two assisted living units (Maricopa and Sespe). Staff Interviews revealed that a fully staffed shift will consist of two (2) caregivers for Maricopa, Matilija and Topa Topa during the AM and PM shift; one (1) caregiver in Sespe for the AM and PM shift, one (1) caregiver in each building during NOC shifts, and one (1) MT for all four buildings in each AM, PM and NOC shift. In addition, the AM and PM shifts will also have one (1) floater to assist all four buildings. During both initial and subsequent visits, the LPA observed all buildings fully staffed. Administrator Amber stated that there was three (3) MT that are no longer at the facility, however the quantity of MT per shift is based on the facility’s needs. Due to the facility not being at capacity, management has decided one (1) MT per shift would suffice. If the census is 45 to 50 residents, they can increase to two (2) MTs. Two out of three residents interviewed stated that they have no concerns and that there is sufficient staff to care for their care and medical needs. Lastly, staff interviews revealed that they are able to meet the needs of the residents as residents are checked frequently, if the MT is unavailable, the Health Service Director or Administrator will be available to assist. In case of an emergency, and MT is unavailable, caregivers will call 911 to ensure resident safety. Based on the information obtained, there is insufficient evidence to support the claim that here is Insufficient staffing to handle residents needs and medication management. Based on interviews and observations the allegation above is deemed unsubstantiated at this time.

On the allegation that Staff does not have qualifications to be Administrator; it is the reporting party’s concern that the administrator does not meet the qualifications of an administrator for memory care and assisted living. To investigate the allegation LPA conducted a file review, and on 10/20/23 conducted a website search for the administrator’s name in the CCLD Resources/Administrator Certification link, and was able to confirm that the administrator has an active administrator’s certificate at this time. In addition, the Artesian of Ojai facility submitted all required documentation to the department for change of Administrator on 8/15/2023. Based on the information obtained through record review, and web search, there is not sufficient evidence to support this allegation. Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview was conducted with the Administrator. A copy of the report and Appeal Rights were issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

LIC9099 (FAS) - (06/04)

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