Inspection Report Summary
Most inspections found deficiencies related to resident care, staffing, billing, and facility maintenance, with several substantiated complaints about medication mismanagement, delayed refunds, and inadequate supervision. The facility received multiple citations for immediate health and safety risks, including failure to have a certified administrator, inadequate staff clearance, infection control lapses during a COVID-19 outbreak, and unsafe or unsanitary conditions. Civil penalties were issued on several occasions, but no license suspensions or revocations were noted in the available reports. The most recent inspection on August 27, 2025, substantiated a complaint about delayed processing of resident checks and improper late fees, resulting in a citation but no enforcement actions listed. While issues have persisted over time, some investigations found unsubstantiated complaints, and the facility has taken corrective actions in response to prior deficiencies.
Deficiencies (last 5 years)
Deficiencies (over 5 years)
8.6 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
115% worse than California average
California average: 4 deficiencies/yearDeficiencies per year
4
3
2
1
0
Census
Latest occupancy rate
39% occupied
Based on a August 2025 inspection.
This facility has shown a decline in demand based on occupancy rates.
Census over time
Inspection Report
Complaint Investigation
Census: 14
Capacity: 36
Deficiencies: 1
Date: Aug 27, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that the facility did not issue a refund to a resident.
Complaint Details
The complaint was substantiated. The allegation was that the facility did not issue a refund to a resident and delayed cashing resident checks, resulting in late fees. Evidence included interviews, billing statements, and email correspondence confirming billing issues and late fee charges.
Findings
The investigation substantiated the allegation that the facility delayed processing resident checks and improperly assessed late fees, resulting in a potential overbilling discrepancy of $3,043.54. Documentation and interviews confirmed billing issues and poor communication, leading to the issuance of a citation.
Deficiencies (1)
Failure to process checks received in the mail in a timely manner, posing a potential risk to residents.
Report Facts
Late fee charges: 3800
Refund amount: 756.46
Potential overbilling discrepancy: 3043.54
Late fee charges refunded: 500
Late fee charges of $100: 800
Late fee charges of $250: 3000
Deficiency due date: Sep 10, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Mark Jeffries | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Lisa Gerr | Administrator | Facility administrator interviewed during investigation. |
| Cielo Valladares | Wellness Director | Met with Licensing Program Analyst during the investigation. |
| Kelly Burley | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation. |
| Staff 1 | Business Office Manager | Sent email acknowledging billing issues; no response to follow-up contact. |
Inspection Report
Complaint Investigation
Census: 15
Capacity: 36
Deficiencies: 1
Date: Jun 25, 2025
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that staff were mismanaging residents' medications.
Complaint Details
The complaint alleged staff were mismanaging residents' medications. The investigation found that Resident 1's medication Olanzapine 2.5mg was missing at discharge and was only delivered to the new facility 18 days later. The allegation was substantiated based on interviews and documentation.
Findings
The investigation substantiated the allegation that staff mismanaged medications, specifically that the medication Olanzapine 2.5mg was missing when Resident 1 was discharged. Documentation and interviews confirmed the medication was in facility custody but was not provided to the resident's responsible party at discharge and was delivered late to the new facility.
Deficiencies (1)
Upon discharge of a resident, all cash resources, personal property and valuables of that resident which have been entrusted to the licensee shall be surrendered to the resident, or his responsible person. A signed receipt shall be obtained. This requirement was not met by evidence of Medication Delivery Record date and date specific medication was not provided to R1's representative, posing an imminent risk to residents in care.
Report Facts
Capacity: 36
Census: 15
Medication quantity: 30
Plan of Correction due date: Jun 26, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lisa Gerr | Administrator | Named in medication mismanagement finding and interviews |
| Mark Jeffries | Licensing Program Analyst | Conducted the complaint investigation |
| Kelly Burley | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 16
Capacity: 36
Deficiencies: 2
Date: May 21, 2025
Visit Reason
Unannounced visit to continue investigation of a subsequent complaint regarding staff clearance and facility documentation.
Complaint Details
Visit was a follow-up to a complaint investigation. The complaint was substantiated by findings of staff clearance and documentation deficiencies.
Findings
The inspection found that Direct Care Staff 1 was not registered or cleared in the required systems for one day, and the facility did not have a Register of Residents available upon demand. Two citations and a civil penalty were issued.
Deficiencies (2)
Direct Care Staff 1 was not cleared in Guardian or Licensing Information Systems at time of visit, posing a risk to residents.
Facility did not have a Register of Residents (LIC9020) available upon demand during normal business hours.
Report Facts
Civil penalty issued: 1
Citations issued: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lisa Gerr | Administrator | Met with Licensing Program Analyst during inspection and provided information about staff clearance and facility documentation. |
| Mark Jeffries | Licensing Program Analyst | Conducted the inspection and issued citations and civil penalty. |
Inspection Report
Follow-Up
Census: 15
Capacity: 36
Deficiencies: 1
Date: Apr 16, 2025
Visit Reason
A Case Management visit was conducted to address deficiencies noted during a Complaint investigation visit on 04/16/2025, specifically concerning the acceptance of a non-conserved resident without a dementia diagnosis in the locked memory care facility.
Complaint Details
The visit was conducted to address deficiencies noted during Complaint Control #29-AS-20250310083615 investigation visit conducted on 04/16/2025.
Findings
The licensee accepted a non-conserved individual who does not have a dementia diagnosis and does not require the level of care provided by the facility, posing an immediate health and safety risk to residents in care.
Deficiencies (1)
Licensee accepted a non-conserved individual who does not have a dementia diagnosis and does not require the level of care provided by the facility.
Report Facts
Capacity: 36
Census: 15
Plan of Correction Due Date: Apr 18, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kristin Kontilis | Licensing Program Analyst | Conducted the Case Management visit |
| Kelly Burley | Licensing Program Manager | Named in the report as Licensing Program Manager |
| Lisa Gerr | Administrator/Director | Facility Administrator named in relation to the deficiency |
| Eve Guerra | Business Office Director | Met with during the inspection |
Inspection Report
Census: 16
Capacity: 36
Deficiencies: 0
Date: Apr 4, 2025
Visit Reason
The visit was conducted to verify the Chapter 7 Bankruptcy Report filed by Pacifica Senior Living as reported by the media.
Findings
The meeting confirmed that despite multiple lawsuits against Pacifica Senior Living and its properties, there was no financial impact on the facilities, residents, or staff. Management communicated that Pacifica Senior Living was no longer the management company for the communities, and there were no vendor issues or other pending lawsuits against the entities.
Report Facts
Lawsuit amount: 25000000
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Carl Knepler | Chief Executive Officer | Provided information regarding lawsuits and financial impact |
| Stacy Barlow | Assistant Program Administrator | Conducted the meeting to verify bankruptcy report |
| Shelley Grace | Assistant Branch Chief, CCLD | Present during the meeting |
| Craig Lundgren | Legal Counsel, CCLD | Present during the meeting |
| Marlene Nelson | Director, Quality Assurance and Risk Management | Present during the meeting |
Inspection Report
Follow-Up
Census: 16
Capacity: 36
Deficiencies: 1
Date: Mar 19, 2025
Visit Reason
This Case Management visit was conducted to address deficiencies noted during a complaint investigation visit on 3/19/2025, specifically to discuss the reporting of a resident death as required by regulation 87211(a)(1)(A).
Complaint Details
The visit was conducted following a complaint investigation (Complaint Control #29-AS-20250310083615) regarding the failure to report a resident's death within the required timeframe. The deficiency was substantiated.
Findings
The licensee failed to report the death of a resident on 3/3/2025 to the Community Care Licensing Division until 3/11/2025, which was identified as an oversight and poses an immediate health and safety risk to residents in care.
Deficiencies (1)
Failure to report the death of a resident within the required seven-day period as per regulation 87211(a)(1)(A).
Report Facts
Census: 16
Total Capacity: 36
Deficiencies cited: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lisa Gerr | Administrator | Named in relation to the failure to report resident death |
| Kelly Burley | Licensing Program Manager | Supervisor overseeing the inspection |
| Kristin Kontilis | Licensing Evaluator | Evaluator conducting the inspection |
Inspection Report
Annual Inspection
Census: 14
Capacity: 36
Deficiencies: 3
Date: Feb 24, 2025
Visit Reason
An unannounced annual required inspection was conducted to assess compliance with licensing regulations for the memory care facility.
Findings
The inspection found deficiencies including failure to properly associate three staff members to the facility prior to employment, failure to notify the department of a resident's hospice placement within five business days, and improper storage of food items posing potential health and safety risks.
Deficiencies (3)
Three staff members were not properly associated to the facility prior to working, posing an immediate health and safety risk.
Failure to notify the Department within five working days of Resident 1's placement on hospice care.
Approximately 16 heads of iceberg lettuce were stored loosely without proper packaging or date stamping, violating food safety requirements.
Report Facts
Residents in care: 14
Total licensed capacity: 36
Hospice waiver capacity: 10
Residents on hospice: 2
Heads of iceberg lettuce observed: 16
Staff improperly associated: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lisa Gerr | Administrator | Named in relation to deficiencies regarding staff association and hospice notification |
| Kristin Kontilis | Licensing Program Analyst | Conducted the inspection and documented findings |
| Kelly Burley | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Capacity: 36
Deficiencies: 1
Date: Jun 11, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted due to an allegation that a resident became septic as a result of neglect at the facility.
Complaint Details
The complaint alleged neglect resulting in a resident becoming septic while in care. The investigation found that the facility failed to provide necessary medications and care, leading to untreated chronic conditions and sepsis. The allegation was substantiated.
Findings
The investigation substantiated the allegation that the facility failed to ensure the resident's medication needs were met, resulting in untreated chronic conditions and sepsis. The facility did not properly manage the resident's diabetes and medication regimen, contributing to the resident's decline and hospitalization.
Deficiencies (1)
Every facility required to be licensed under this chapter shall provide at least the following basic services: (a) Care and supervision as defined in Section 1569.2. This requirement is not met as evidenced by failure to ensure resident's medication needs were met.
Report Facts
Facility capacity: 36
Deficiency count: 1
Plan of Correction due date: Jun 12, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Melisa Rankin | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Kelly Burley | Licensing Program Manager | Oversaw the complaint investigation process |
| Cynthia Garcia | Administrator | Facility administrator met during the investigation and was informed of findings |
Inspection Report
Complaint Investigation
Census: 14
Capacity: 36
Deficiencies: 0
Date: Jun 11, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit conducted due to multiple allegations including neglect resulting in dehydration, a fall, vaccination without consent, failure to notice a change in resident's condition, and restricting resident communication with family members.
Complaint Details
The complaint involved allegations of neglect causing dehydration and a fall, vaccination without consent, failure to notice changes in the resident's condition, and restricting communication with family. All allegations were investigated and deemed unsubstantiated due to insufficient evidence.
Findings
The investigation found insufficient evidence to substantiate any of the allegations. The resident's dehydration, fall, vaccination without consent, failure to notice condition changes, and communication restrictions were all deemed unsubstantiated. Technical assistance was provided to ensure adequate staff support for resident communication.
Report Facts
Facility capacity: 36
Resident census: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Melisa Rankin | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Kelly Burley | Licensing Program Manager | Oversaw the complaint investigation |
| Cynthia Garcia | Administrator | Facility administrator met with Licensing Program Analyst during the visit |
Inspection Report
Complaint Investigation
Census: 14
Capacity: 36
Deficiencies: 2
Date: Jun 11, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations that staff did not provide a resident's responsible party with records after requested and did not allow visitors into the facility in a timely manner.
Complaint Details
The complaint was substantiated. Staff did not provide resident's responsible party with records after multiple requests dating back to 2020 and 2022. Staff also did not allow visitors into the facility in a timely manner, with wait times up to an hour. Licensing Program Analyst Melisa Rankin conducted the investigation.
Findings
The investigation substantiated both allegations: the facility failed to provide requested resident records despite multiple requests, and visitors experienced long wait times, up to 45 minutes to an hour, to be admitted to the facility.
Deficiencies (2)
Personal Rights. Visitors were not permitted to visit privately during reasonable hours and without prior notice in a timely manner.
Personal Rights. Facility failed to provide prompt access to review and photocopy resident records within two business days.
Report Facts
Capacity: 36
Census: 14
Deficiencies cited: 2
Plan of Correction Due Dates: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Melisa Rankin | Licensing Program Analyst | Conducted the complaint investigation and issued findings |
| Kelly Burley | Licensing Program Manager | Oversaw the complaint investigation |
| Cynthia Garcia | Administrator | Facility administrator met with Licensing Program Analyst during investigation |
| Miriam Santiago | Administrator | Named as facility administrator in report header |
Inspection Report
Complaint Investigation
Census: 14
Capacity: 36
Deficiencies: 0
Date: Jun 11, 2024
Visit Reason
Unannounced complaint investigation visit conducted in response to multiple allegations regarding resident care at Pacifica Senior Living Santa Barbara.
Complaint Details
The complaint involved allegations that staff did not notice changes in a resident's condition, failed to assist with hygiene needs, did not administer medications as prescribed, did not feed the resident, lacked sufficient staffing, and failed to communicate with the resident's representatives. The investigation concluded these allegations were unsubstantiated due to insufficient evidence.
Findings
The investigation found insufficient evidence to substantiate any of the allegations related to resident care, medication administration, feeding, hygiene assistance, staffing levels, and communication with resident representatives. All allegations were deemed unsubstantiated.
Report Facts
Capacity: 36
Census: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Melisa Rankin | Licensing Program Analyst | Conducted the complaint investigation visit |
| Kelly Burley | Licensing Program Manager | Oversaw the complaint investigation |
| Miriam Santiago | Administrator | Facility administrator involved in the investigation |
| Cynthia Garcia | Administrator | Met with Licensing Program Analyst during the visit |
Inspection Report
Complaint Investigation
Census: 14
Capacity: 36
Deficiencies: 1
Date: Jun 11, 2024
Visit Reason
This was an unannounced complaint investigation visit triggered by a complaint received on 2022-12-01 regarding multiple allegations including unsafe and unsanitary environment, failure to provide clean linens, neglect resulting in resident falls and injuries, inadequate supervision, and failure to respond timely to residents' change of condition.
Complaint Details
The complaint investigation was substantiated for allegations of unsafe and unsanitary environment and failure to provide clean linens. Allegations related to resident falls resulting in injury, failure to respond timely to change of condition, inadequate supervision, and failure to meet residents' needs were unsubstantiated. The investigation included interviews, observations, and review of documents. Multiple residents required hospital care following an incident on 2022-11-26, but no serious injuries were confirmed.
Findings
The investigation substantiated allegations that staff did not ensure a safe and sanitary environment and failed to provide clean linens. Several health and safety hazards were observed including old feces in hallways and bathrooms, soiled linens, and lack of cleaning logs. Other allegations related to resident falls, inadequate supervision, and failure to meet residents' needs were found unsubstantiated due to insufficient evidence.
Deficiencies (1)
Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by unclean and unsafe conditions posing potential health and safety risks to residents.
Report Facts
Facility Capacity: 36
Census: 14
Deficiency Type: 1
COVID-19 Positive Residents: 19
Residents Observed: 21
Staffing: 3
Staffing: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Melisa Rankin | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Kelly Burley | Licensing Program Manager | Oversaw the complaint investigation |
| Miriam Santiago | Administrator | Facility administrator named in the report and interviewed during investigation |
| Cynthia Garcia | Administrator | Met with Licensing Program Analyst during inspection visit |
Inspection Report
Complaint Investigation
Census: 14
Capacity: 36
Deficiencies: 0
Date: Jun 11, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2024-02-27 regarding activities, special diet adherence, and medication administration at Pacifica Senior Living Santa Barbara.
Complaint Details
The complaint included allegations that staff did not ensure residents were provided activities, did not adhere to a resident's special diet as prescribed, and did not ensure medication was provided as prescribed. All allegations were deemed unsubstantiated based on observations, document reviews, and interviews.
Findings
The investigation found insufficient evidence to substantiate the allegations. Activities were observed and residents reported satisfaction, no official special diet order was found for the resident in question, and medication administration procedures were followed with proper communication and documentation.
Report Facts
Facility capacity: 36
Census: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Melisa Rankin | Licensing Program Analyst | Conducted the complaint investigation visit and authored the report |
| Kelly Burley | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Cynthia Garcia | Administrator | Met with Licensing Program Analyst during the investigation and provided information |
| Elizabeth Hernandez | Designee | Met with Licensing Program Analyst during the investigation |
Inspection Report
Complaint Investigation
Census: 14
Capacity: 36
Deficiencies: 0
Date: Jun 11, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 2024-06-04 regarding staff mismanaging residents' medication, facility toilet disrepair, facility cleanliness, and staff verbal altercation in presence of residents.
Complaint Details
The complaint included allegations of staff mismanaging residents' medication, a clogged and backed-up toilet, facility being dirty, and staff engaging in a verbal altercation in presence of residents. After investigation, all allegations were found to be unsubstantiated.
Findings
All allegations were investigated through interviews, facility tour, and document review. The allegations of medication mismanagement, toilet disrepair, facility dirtiness, and staff verbal altercation were all deemed unsubstantiated based on the information obtained and observations during the visit.
Report Facts
Facility capacity: 36
Census: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Melisa Rankin | Licensing Program Analyst | Conducted the complaint investigation visit |
| Kelly Burley | Licensing Program Manager | Named as Licensing Program Manager on report |
| Maria Rossi | Administrator | Facility administrator interviewed during investigation |
| Cynthia Garcia | Administrator | Met with Licensing Program Analyst during visit |
| Elizabeth Hernandez | Designee | Explained reason for visit and participated in investigation |
Inspection Report
Complaint Investigation
Census: 14
Capacity: 36
Deficiencies: 1
Date: Jun 3, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that the facility did not give a refund to prospective residents after they decided not to move in.
Complaint Details
The complaint alleged that the facility did not refund pre-admission fees to two prospective residents who decided not to move in. The allegation was substantiated based on interviews, documentation, and confirmation from facility management.
Findings
The investigation substantiated that the facility failed to refund pre-admission fees to two prospective residents who never moved in and did not sign an admission agreement. The facility manager confirmed the fees should have been refunded and was working with accounting to issue the refunds.
Deficiencies (1)
Admission Agreements. A 100 percent refund of a preadmission fee shall be provided if the applicant decides not to enter the facility. This requirement was not met as evidenced by the failure to refund pre-admission fees to prospective residents, posing a potential personal rights risk.
Report Facts
Pre-admission fee amount: 3776.1
Pre-admission fee amount: 1726.1
Capacity: 36
Census: 14
Plan of Correction Due Date: Jun 11, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Melisa Rankin | Licensing Program Analyst | Conducted the complaint investigation and issued the report |
| Kelly Burley | Licensing Program Manager | Oversaw the complaint investigation |
| Miriam Santiago | Administrator | Interviewed regarding the refund issue |
Inspection Report
Complaint Investigation
Census: 14
Capacity: 36
Deficiencies: 0
Date: May 6, 2024
Visit Reason
The inspection visit was conducted as a complaint investigation following an allegation that a resident sustained injuries while in care.
Complaint Details
The complaint alleged that on 6/20/2023, Resident 1 was observed with bruises on their hand/arm, allegedly caused by staff due to violent behavior. The resident and staff interviews, along with documentation, indicated the injuries were from falls and aggressive behaviors related to dementia. The allegation was unsubstantiated.
Findings
The investigation found insufficient evidence to prove that the resident sustained injury due to staff neglect or abuse. The allegation was deemed unsubstantiated based on interviews with the resident and staff, review of documentation, and observation of injury photos.
Report Facts
Facility capacity: 36
Census: 14
Complaint control number: 29-AS-20230623160720
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Melisa Rankin | Licensing Program Analyst | Conducted the complaint investigation visit and issued final findings |
| Kelly Burley | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Capacity: 36
Deficiencies: 3
Date: May 6, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2023-09-05 regarding infection control, provision of basic supplies, cleanliness, and facility disrepair at Pacifica Senior Living Santa Barbara.
Complaint Details
The complaint investigation was substantiated. Allegations included failure to follow infection control procedures during a COVID-19 outbreak, lack of basic supplies due to lost keys to laundry room, facility cleanliness issues, and disrepair such as clogged toilets and broken fixtures. Evidence included staff and visitor interviews, invoices for locksmith and plumbing services, and direct observations by Licensing Program Analysts.
Findings
The investigation substantiated multiple allegations including failure to follow infection control procedures during a COVID-19 outbreak due to inaccessible cleaning supplies, lack of access to basic supplies such as towels and toilet paper, and ongoing plumbing and maintenance issues causing unsanitary conditions and disrepair. The facility provided evidence of corrective actions such as locksmith services and plans to fix maintenance issues.
Deficiencies (3)
Facility did not comply with infection control requirements as disinfectants and cleaning supplies were not available during a COVID outbreak, posing an immediate health and safety risk.
Facility did not provide necessary personal accommodations and supplies such as toilet paper, towels, and hygiene products, posing an immediate health and safety risk.
Facility was not clean or in good repair, including water damage to ceiling, broken heater, medication room door not securely locking, and broken doorknob in resident room, posing potential health and safety risks.
Report Facts
Capacity: 36
Plan of Correction Due Date: 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Melisa Rankin | Licensing Program Analyst | Conducted the complaint investigation and subsequent visits |
| Kelly Burley | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Miriam Santiago | Administrator | Facility administrator named in the report |
Inspection Report
Complaint Investigation
Census: 14
Capacity: 36
Deficiencies: 2
Date: May 6, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2023-12-12 regarding lack of a certified administrator and inadequate care and supervision of residents.
Complaint Details
The complaint investigation was substantiated. Allegations included the facility lacking a certified administrator from July 12, 2023 to October 11, 2023 and from December 18, 2023 to present, and staff not providing adequate care and supervision, evidenced by a resident eloping on two occasions. Multiple interviews and record reviews confirmed these findings.
Findings
The investigation substantiated that the facility did not have a certified administrator for several months, posing an immediate health and safety risk. Additionally, staff failed to provide adequate supervision, resulting in a resident eloping from the facility, which also posed an immediate health and safety risk.
Deficiencies (2)
87405(a) Administrator Qualifications and Duties. Facility did not have a qualified and currently certified administrator for months, posing an immediate health and safety risk to residents.
87468.2(a)(4) Personal Rights. Insufficient supervision allowed a resident to elope, posing an immediate health and safety risk to residents.
Report Facts
Capacity: 36
Census: 14
Deficiencies cited: 2
Plan of Correction Due Date: May 7, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Melisa Rankin | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Kelly Burley | Licensing Program Manager | Oversaw the complaint investigation |
| Karen DaCome | Administrator | Named as facility administrator at time of report |
| Tierre Thorton | Regional Director of Operations | Named as Administrator in documents submitted to CCL |
| Cynthia Garcia | Met with Licensing Program Analyst during inspection |
Inspection Report
Complaint Investigation
Census: 13
Capacity: 36
Deficiencies: 0
Date: Mar 6, 2024
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that staff did not ensure residents received mail correspondence in a timely manner between 02/16/2024 and 02/20/2024.
Complaint Details
The complaint alleged that postal mail was not retrieved for Resident #1 from 02/16/2024 through 02/20/2024, with staff unavailable or lacking mailbox keys. The investigation included interviews, observations, and document reviews. No staff admitted to receiving mail for Resident #1, and there was insufficient evidence to prove the allegation, resulting in an unsubstantiated finding.
Findings
The investigation found no evidence of late or undelivered mail; mail was properly stored and distributed, and staff confirmed procedures for mail handling. Interviews with residents and staff indicated mail was received timely, and the allegation was deemed unsubstantiated.
Report Facts
Facility capacity: 36
Census: 13
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Brian Phillips | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Cynthia Garcia | Business Office Director | Interviewed during the investigation regarding mail procedures |
| Anais Ochoa | Medication Technician | Interviewed during the investigation regarding mail procedures |
| Karen Dacome | Administrator | Facility administrator named in the report |
| Kelly Burley | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Annual Inspection
Census: 14
Capacity: 36
Deficiencies: 0
Date: Feb 13, 2024
Visit Reason
The visit was a Case Management - Annual Continuation inspection conducted to evaluate the facility's compliance and review staff records for background checks.
Findings
The Licensing Program Analyst conducted a tour of the facility and reviewed staff records. The inspection was not completed and will be continued at a later date.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kristin Kontilis | Licensing Program Analyst | Conducted the Case Management - Annual Continuation visit |
| Tierre Thornton | Regional Director of Operations | Met with Licensing Program Analyst during the visit |
Inspection Report
Annual Inspection
Census: 14
Capacity: 36
Deficiencies: 2
Date: Jan 30, 2024
Visit Reason
An unannounced annual required inspection was conducted to assess compliance with regulations at the Pacifica Senior Living Santa Barbara facility.
Findings
The inspection found deficiencies related to fire safety due to expired fire extinguisher inspections and maintenance and operation issues due to foul odors in some resident bedrooms and bathrooms. Civil penalties were issued and plans of correction were agreed upon.
Deficiencies (2)
Fire inspection service on five out of five fire extinguishers was expired as of 1/5/2023, posing an immediate health and safety risk.
Two residents' bedrooms and two residents' bathrooms had foul odors posing an immediate health and safety risk.
Report Facts
Fire extinguishers inspected: 5
Resident rooms inspected: 14
Total capacity: 36
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kristin Kontilis | Licensing Program Analyst | Conducted the inspection and authored the report. |
| Cynthia Garcia | Business Office Director | Met with Licensing Program Analyst during inspection. |
| Karen Dacome | Administrator | Facility administrator named in the report. |
| Kelly Burley | Licensing Program Manager | Supervisor overseeing the inspection. |
Inspection Report
Complaint Investigation
Census: 14
Capacity: 36
Deficiencies: 2
Date: Jan 24, 2024
Visit Reason
This was an unannounced complaint investigation visit triggered by allegations received on 2024-01-17 regarding lack of staffing causing unanswered facility phone calls and failure to notify an authorized representative of an incident with a resident.
Complaint Details
The complaint was substantiated. The allegations included staff not answering the facility phone due to lack of staffing and failure to notify an authorized representative of a resident's hospital emergency room visit. Both allegations were confirmed based on interviews, record reviews, and observations.
Findings
The investigation substantiated that due to lack of staffing, facility staff were unable to answer telephone calls on multiple occasions, posing an immediate health and safety risk. Additionally, the facility failed to notify the authorized representative and Community Care Licensing Division of a resident's hospital emergency room visit.
Deficiencies (2)
Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as staff were unable to answer telephone calls from a resident's responsible party on multiple dates, posing an immediate health and safety risk.
Licensee shall furnish written reports to the licensing agency and responsible parties within seven days of specified events. This requirement was not met as the facility staff did not notify the resident's responsible party or CCLD of a hospital visit.
Report Facts
Deficiencies cited: 2
Capacity: 36
Census: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kristin Kontilis | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Kelly Burley | Licensing Program Manager | Named in the report as Licensing Program Manager overseeing the investigation. |
| Anais Ochoa | Medication Technician | Met with the Licensing Program Analyst during the investigation and provided information regarding staffing and phone answering. |
Inspection Report
Census: 14
Capacity: 36
Deficiencies: 0
Date: Dec 18, 2023
Visit Reason
An unannounced case management visit was conducted to follow up on an immediate exclusion order issued on 11/16/2023 for Staff 1 (S1).
Findings
The Licensing Program Analyst confirmed that Staff 1 had not been physically present in the facility since 12/6/2023 and was disassociated from the facility's fingerprint clearance roster during the visit. The facility was reminded that any further presence of Staff 1 would violate the exclusion order and could result in deficiencies and civil penalties.
Report Facts
Facility capacity: 36
Census: 14
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kristin Kontilis | Licensing Program Analyst | Conducted the unannounced case management visit |
| Karen Dacome | Administrator | Facility administrator named in the report header |
| Cynthia Garcia | Business Office Manager | Met with Licensing Program Analyst during the visit and disassociated Staff 1 from fingerprint roster |
| Tierre Thornton | Regional Director of Operations | Provided information regarding Staff 1's absence from the facility |
| Marco Quintanar | Program Manager, Long Term Care Ombudsman | Accompanied Licensing Program Analyst during the visit |
| Allie Sotelo | Medication Technician | Met with Licensing Program Analyst and LTCO during the visit |
Inspection Report
Complaint Investigation
Census: 19
Capacity: 36
Deficiencies: 1
Date: Jun 13, 2023
Visit Reason
An unannounced complaint investigation visit was conducted due to an allegation that facility staff did not issue a timely refund in the event of a resident’s death.
Complaint Details
The complaint alleged that facility staff did not issue a timely refund after a resident's death. The investigation found that the refund was not issued within the required 15-day period, and the allegation was substantiated.
Findings
The investigation substantiated that the licensee failed to issue a refund within fifteen days after the resident's belongings were removed following the resident's death, violating California regulations.
Deficiencies (1)
Failure to issue a refund within 15 days after the resident's personal property was removed from the facility following the resident's death, as required by HSC 1569.652(c).
Report Facts
Capacity: 36
Census: 19
Deficiency count: 1
Plan of Correction Due Date: Jun 15, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kristin Kontilis | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Miriam Santiago | Administrator | Facility administrator involved in the investigation and cited in findings |
| Kelly Burley | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 20
Capacity: 36
Deficiencies: 1
Date: May 30, 2023
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that the facility did not issue a prospective resident a refund of the deposit paid after deciding not to move in.
Complaint Details
The complaint was substantiated. The allegation was that the facility did not give a prospective resident a refund of the deposit paid after deciding not to move in. The responsible party was owed a refund of $2,500 which was not issued within 15 days as required.
Findings
The investigation substantiated that the facility failed to issue a refund of $2,500 to the prospective resident's responsible party within the required timeframe after the resident decided not to move in. The facility withheld $500 for a preassessment but did not comply with refund policies as required by regulations.
Deficiencies (1)
Admission agreements did not comply with refund conditions requiring at least 80 percent refund of preadmission fees in excess of $500 if the applicant does not enter the facility after a preadmission appraisal.
Report Facts
Refund amount: 2500
Deposit amount: 3000
Withheld amount: 500
Estimated days of completion: 90
Capacity: 36
Census: 20
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Miriam Santiago | Administrator | Named in relation to the refund allegation and investigation |
| Kristin Kontilis | Licensing Program Analyst | Conducted the complaint investigation |
| Kelly Burley | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Annual Inspection
Census: 18
Capacity: 36
Deficiencies: 1
Date: Feb 21, 2023
Visit Reason
An unannounced one-year Infection Control Inspection visit was conducted to assess compliance with infection control and facility regulations.
Findings
The facility was generally compliant with infection control practices, maintaining cleanliness, adequate PPE supplies, and proper resident accommodations. However, a deficiency was cited for a staff member not wearing a face covering correctly, posing an immediate health and safety risk.
Deficiencies (1)
Facility failed to ensure Staff 1 was wearing a face covering correctly, posing an immediate health, safety, and personal rights risk to residents.
Report Facts
Capacity: 36
Census: 18
PPE supply: 30
Fire extinguishers: 3
Fire pull alarms: 5
Plan of Correction Due Date: Feb 23, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Miriam Santiago | Administrator | Facility Administrator who greeted the Licensing Program Analyst and is responsible for infection control plans |
| Kristin Kontilis | Licensing Program Analyst | Conducted the inspection and authored the report |
| Kelly Burley | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Follow-Up
Census: 18
Capacity: 36
Deficiencies: 2
Date: Feb 21, 2023
Visit Reason
The visit was a Case Management follow-up to address deficiencies noted during a required Annual Infection Control Inspection conducted on 02/21/2023.
Findings
The facility failed to submit required hospice notifications since 6/18/2021 and death reports since 9/11/2021, posing immediate health and safety risks. Deficiencies were cited related to noncompliance with California Code of Regulations hospice care waiver and reporting requirements.
Deficiencies (2)
Failure to notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident or admitting a resident already receiving hospice care services.
Failure to report the death of any resident from any cause regardless of where the death occurred within required timeframes.
Report Facts
Capacity: 36
Census: 18
Plan of Correction Due Date: Feb 23, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kristin Kontilis | Licensing Program Analyst | Conducted the Case Management visit and cited deficiencies |
| Kelly Burley | Licensing Program Manager | Supervisor overseeing the inspection |
| Miriam Santiago | Administrator | Facility administrator counseled during the visit |
Inspection Report
Plan of Correction
Capacity: 36
Deficiencies: 2
Date: Dec 14, 2022
Visit Reason
An unannounced Plan of Correction (POC) visit was conducted due to the facility's failure to submit serious illness/injury reports and a plan of correction for deficiencies cited on 12/5/2022.
Findings
The facility did not submit the required serious illness/injury reports for five residents within seven days, nor did it submit the plan of correction by the due date. Civil penalties were assessed and will continue to accrue until proof of correction is received.
Deficiencies (2)
Failure to submit serious illness/injury reports to CCL within seven days for five residents.
Failure to submit a plan of correction for the cited deficiency by the due date.
Report Facts
Civil penalties assessed: 800
Number of residents involved: 5
Days penalty accrued: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Miriam Santiago | Administrator | Met with Licensing Program Analyst during the visit and named in relation to failure to submit reports and plan of correction. |
| Kristin Kontilis | Licensing Program Analyst | Conducted the unannounced Plan of Correction visit. |
| Kelly Burley | Licensing Program Manager | Named in the report header. |
Inspection Report
Complaint Investigation
Census: 18
Capacity: 36
Deficiencies: 1
Date: Dec 14, 2022
Visit Reason
An unannounced Case Management – Incident visit was conducted following a report by the facility administrator of twenty-one new COVID-19 positive cases. The visit aimed to review compliance with reporting requirements related to these cases.
Complaint Details
The visit was complaint-related due to the report of 21 new COVID-19 positive cases. The deficiency was substantiated as the facility did not submit required reports within seven days.
Findings
The facility failed to submit serious illness/injury reports to the licensing agency within seven days for all twenty-one COVID-19 cases reported on 11/28/2022, resulting in a cited deficiency and a civil penalty assessment.
Deficiencies (1)
Failure to submit written reports to the licensing agency within seven days of occurrence for incidents threatening resident welfare, specifically 21 serious injury/incident reports related to COVID-19 cases were not received within the required timeframe.
Report Facts
COVID-19 positive cases reported: 21
Serious injury/incident reports not submitted: 21
Capacity: 36
Census: 18
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Miriam Santiago | Administrator | Reported the COVID-19 cases and was met during the inspection |
| Kristin Kontilis | Licensing Program Analyst | Conducted the unannounced Case Management – Incident visit |
| Kelly Burley | Licensing Program Manager | Named as Licensing Program Manager overseeing the inspection |
Inspection Report
Follow-Up
Capacity: 36
Deficiencies: 1
Date: Dec 5, 2022
Visit Reason
The visit was a Case Management follow-up conducted to address deficiencies noted during a prior complaint investigation visit related to incidents involving multiple residents being taken to the hospital.
Complaint Details
The visit was triggered by a complaint alleging multiple residents were taken to the hospital due to health and safety concerns on 11/26/2022. The complaint was investigated but no incidents of serious illness or injury reports were received by the licensing agency for five residents involved.
Findings
The licensee failed to submit 5 out of 5 serious injury/incident reports to the licensing agency within seven days of occurrence, posing an immediate health and safety risk to residents in care.
Deficiencies (1)
Failure to submit required written reports to the licensing agency within seven days for incidents threatening the welfare, safety, or health of residents.
Report Facts
Deficiencies cited: 1
Facility capacity: 36
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Ana Delgado | Medication Technician | Met with during the visit and explained the purpose of the visit |
| Miriam Santiago | Administrator | Facility administrator unavailable during the visit |
| Kristin Kontilis | Licensing Program Analyst | Conducted the Case Management visit |
| Kelly Burley | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 20
Capacity: 36
Deficiencies: 1
Date: Nov 14, 2022
Visit Reason
The inspection visit was an unannounced case management visit to investigate complaint #29-AS-2022110412253523 regarding facility compliance.
Complaint Details
Investigation of complaint #29-AS-2022110412253523. Deficiency substantiated based on observation of Administrator not wearing a face covering in the presence of residents.
Findings
The facility was found deficient for failing to ensure the Administrator and staff were wearing face coverings, posing an immediate health, safety, and personal rights risk to residents.
Deficiencies (1)
Failure to ensure Administrator/staff were wearing face coverings, posing an immediate health, safety, and personal rights risk to residents.
Report Facts
Capacity: 36
Census: 20
Deficiency count: 1
Plan of Correction Due Date: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Miriam Santiago | Administrator | Observed not wearing face covering during inspection |
| Kristin Kontilis | Licensing Program Analyst | Conducted the unannounced complaint investigation visit |
| Kelly Burley | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 19
Capacity: 36
Deficiencies: 1
Date: Sep 16, 2022
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that the facility improperly increased resident rates, specifically concerning Resident 1 who was promised a two-year rate guarantee.
Complaint Details
The complaint was substantiated. The investigation confirmed that Resident 1's rate was improperly increased despite a two-year rate guarantee. The facility rescinded the rate increase after the issue was raised.
Findings
The allegation was substantiated. The facility did not comply with the admission agreement by increasing Resident 1's rate despite a two-year rate lock. The facility rescinded the rate increase during the investigation visit.
Deficiencies (1)
87507(f) Admission Agreements: The licensee did not comply with the admission agreement by not honoring the no rate increase modification for Resident 1 for at least two years, posing potential health, safety, and personal rights risks.
Report Facts
Capacity: 36
Census: 19
Deficiencies cited: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kristin Kontilis | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Kelly Burley | Licensing Program Manager | Oversaw the complaint investigation |
| Allamary E. Moore | Administrator | Former administrator who confirmed the rate lock for Resident 1 |
| Miriam Santiago | Interim Administrator | Met with during the investigation and communicated with Resident 1's responsible party |
Inspection Report
Complaint Investigation
Census: 19
Capacity: 36
Deficiencies: 2
Date: Sep 16, 2022
Visit Reason
An unannounced case management visit was conducted to issue deficiencies discovered during the investigation of complaint 29-AS-20220627170949.
Complaint Details
The visit was triggered by complaint investigation 29-AS-20220627170949. The complaint was substantiated based on observations of staff not properly wearing masks and lack of designated substitute administrator coverage.
Findings
The licensee failed to ensure a designated substitute administrator was on the premises 24 hours per day, posing a potential health and safety risk. Additionally, staff members were observed not wearing face masks properly, which posed an immediate health, safety, and personal rights risk to residents.
Deficiencies (2)
Failure to ensure a designated substitute on the premises 24 hours per day, posing a potential health and safety risk to residents.
Staff members present in the facility without wearing masks fully covering the mouth and nose, posing an immediate health, safety, and personal rights risk to residents.
Report Facts
Deficiencies cited: 2
Capacity: 36
Census: 19
Plan of Correction Due Date: Sep 19, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Miriam Santiago | Interim Administrator | Named in relation to mask wearing deficiency and administrative coverage. |
| Allamary E. Moore | Administrator | Administrator on record who had been on leave since 10/1/2021. |
Inspection Report
Complaint Investigation
Census: 22
Capacity: 36
Deficiencies: 1
Date: Jul 5, 2022
Visit Reason
The visit was conducted as a Case Management visit in conjunction with a complaint investigation to issue citations for deficiencies observed during the complaint investigation.
Complaint Details
The visit was triggered by a complaint (Complaint Control # 29-AS-20220627170949).
Findings
The facility failed to maintain a clean environment as evidenced by an abandoned washing machine remaining visible to residents, staff, visitors, and passersby, posing a potential health and safety risk.
Deficiencies (1)
An abandoned washing machine was observed in front of the facility visible to residents, visitors, staff, and the public, posing a potential health and safety risk.
Report Facts
Capacity: 36
Census: 22
Plan of Correction Due Date: Jul 7, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Anais Ochoa | Medication Technician | Met with during the visit |
| Kristin Kontilis | Licensing Program Analyst | Conducted the inspection and authored the report |
| Kelly Burley | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 21
Capacity: 36
Deficiencies: 2
Date: Mar 10, 2022
Visit Reason
The inspection visit was conducted as a complaint investigation following allegations that the facility failed to issue a refund and failed to provide a copy of the signed Admission Agreement to the resident or the resident’s representative upon admission.
Complaint Details
The complaint investigation was initiated based on a complaint received on 12/23/2020 alleging failure to issue a refund and failure to provide a copy of the signed Admission Agreement. The allegations were substantiated after interviews and document reviews.
Findings
The investigation substantiated the allegations that the facility did not issue a refund within the required timeframe after the resident's death and removal of personal belongings, and failed to provide a copy of the signed Admission Agreement to the resident’s representative. These deficiencies posed potential health, safety, or personal rights risks to residents in care.
Deficiencies (2)
Failure to issue a refund within 15 days after the resident’s personal property was removed from the facility as required by H&S 1569.652(c).
Failure to provide a copy of the signed Admission Agreement to the resident or resident’s representative immediately upon signing as required by CCR 87507(e).
Report Facts
Refund amount: 4623.39
Refund amount previously paid: 6800.25
Plan of Correction due date: Mar 17, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Toan Luong | Licensing Program Analyst | Conducted the complaint investigation visit and delivered findings |
| Kristin Kontilis | Licensing Program Analyst | Initiated the complaint investigation and conducted interviews |
| Lyndia Sager | Licensing Program Analyst | Conducted interviews and reviewed refund documentation |
| Allamary E. Moore | Administrator | Facility administrator involved in interviews and investigation |
| Miriam Santiago | Business Office Manager / Interim Administrator | Met with Licensing Program Analyst during visit and involved in investigation |
| Kelly Burley | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 21
Capacity: 36
Deficiencies: 2
Date: Mar 10, 2022
Visit Reason
The inspection visit was conducted as a complaint investigation following allegations received on 04/27/2020 regarding resident assault and inadequate staffing at the facility.
Complaint Details
The complaint investigation was substantiated for allegations that a resident assaulted other residents and that the facility was inadequately staffed. The allegation that staff did not follow resident admission procedures was unsubstantiated.
Findings
The investigation substantiated that a resident assaulted other residents and that the facility was not adequately staffed to meet residents' needs, posing immediate health and safety risks. Another allegation regarding staff not following resident admission procedures was found unsubstantiated.
Deficiencies (2)
Licensee failed to provide adequate care and supervision to Resident #1, contributing to aggressive and assaultive incidents on 04/25/2020 and 04/26/2020, posing immediate health, safety, or personal rights risk.
Licensee failed to provide adequate staffing to care for thirteen dementia residents, posing an immediate health, safety, or personal rights risk to residents in care.
Report Facts
Resident count: 21
Total capacity: 36
Residents on hospice: 6
Residents requiring two-person assist: 5
Residents requiring Hoyer lift: 2
Residents requiring one-person assist: 8
Residents requiring feeding assistance: 4
Staff on a.m. and p.m. shifts: 1
Staff on overnight shift: 2
Plan of Correction due date: Mar 11, 2022
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Toan Luong | Licensing Program Analyst | Conducted the complaint investigation and subsequent visits |
| Miriam Santiago | Business Office Manager / Interim Administrator | Met with Licensing Program Analyst during investigation and subsequent visits |
| Kelly Burley | Licensing Program Manager | Named in report as Licensing Program Manager |
| Kristin Kontilis | Licensing Program Analyst | Conducted initial complaint investigation telephonically and subsequent visits |
| Mary Moore | Executive Director | Interviewed during complaint investigation |
| Ahaoma N Onyebuchi | Administrator | Facility Administrator named in report |
| Dr. Winner | Physician | Signed Resident #1's Physician Report |
Inspection Report
Annual Inspection
Census: 20
Capacity: 36
Deficiencies: 1
Date: Feb 25, 2022
Visit Reason
An unannounced One Year Infection Control Annual visit was conducted to evaluate compliance with infection control and licensing requirements.
Findings
The facility lacked California Department of Social Services Provider Information Notices visible to residents and had sinks without paper towels. One individual was found on the schedule without a required Criminal Record Clearance and was removed from the schedule. A citation and civil penalty were issued.
Deficiencies (1)
One staff on the facility roster did not have criminal record clearance as required by Health and Safety Code Section 1569.17(b).
Report Facts
Capacity: 36
Census: 20
Deficiencies cited: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Miriam Santiago | Administrator | Met with Licensing Program Analyst during inspection and responsible for corrective actions |
| Toan Luong | Licensing Program Analyst | Conducted the inspection and issued citation |
| Kelly Burley | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 16
Capacity: 36
Deficiencies: 1
Date: Jul 30, 2021
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2019-10-28 regarding facility conditions and resident care concerns.
Complaint Details
The complaint investigation was substantiated for the allegation of failure to keep the facility free of rodents and/or insects. Other allegations about personal hygiene supplies, accommodations, and staffing were unsubstantiated.
Findings
The investigation substantiated the allegation that the licensee failed to keep the facility free of rodents and/or insects due to unclean bird cages attracting flies and ants. Other allegations regarding inadequate personal hygiene supplies, unsafe accommodations, and insufficient staffing were unsubstantiated.
Deficiencies (1)
Failure to keep the area in and around the bird cage free from flies and ants, posing a potential health risk to clients.
Report Facts
Capacity: 36
Census: 16
Staffing counts: 3
Staffing counts: 3
Staffing counts: 2
Number of birds in cage: 5
Packages of diapers: 30
Residents requiring two-person assist: 6
Residents at facility: 17
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Darlene Chavez | Licensing Program Analyst | Conducted complaint investigation and authored report |
| Kelly Burley | Licensing Program Manager | Oversaw complaint investigation |
| Mary Moore | Administrator | Met with during investigation and involved in exit interview |
| Miriam Santiago | Business Office Manager | Met with during investigation and provided information on supplies and staffing |
Report
February 25, 2026
Report
January 15, 2026
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