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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425801580
Report Date: 07/29/2021
Date Signed: 07/29/2021 02:16:39 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/10/2019 and conducted by Evaluator Kristin Kontilis
COMPLAINT CONTROL NUMBER: 29-AS-20190910101511
FACILITY NAME:ABUNDANT CARE IIIFACILITY NUMBER:
425801580
ADMINISTRATOR:DANIEL BONDFACILITY TYPE:
740
ADDRESS:4589 AUHAY DRIVETELEPHONE:
(805) 689-6900
CITY:SANTA BARBARASTATE: CAZIP CODE:
93110
CAPACITY:6CENSUS: 6DATE:
07/29/2021
UNANNOUNCEDTIME BEGAN:
10:53 AM
MET WITH:Timothy Pryko, AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff engage in inappropriate interactions with resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced complaint visit regarding the above allegation. During the investigation, LPA interviewed residents on 9/17/2019, 10/11/2019, and 2/15/2020, interviewed staff on 9/17/2019, 2/15/2020, and 2/23/2020; and interviewed credible witnesses on 9/17/2019 and 10/11/2019. LPA also collected and reviewed relevant documents on 9/19/2019, 2/23/2020 and 2/25/2020.
Allegation #1: Staff engage in inappropriate interactions with resident. It was alleged facility staff were using intimidation measures to convince R1 to resume taking Prozac. R1 stated in writing that facility staff, including Administrator, were intimidating R1 to resume taking Prozac. R1 stated Administrator came into R1’s room and threatened R1 with eviction if R1 refused to resume taking medication (Prozac).
Previously, R1 was prescribed Prozac but R1’s physician had lowered the dosage until R1 stopped taking the medication. LPA reviewed an incident report dated 7/19/2019 stating R1 stopped the prescribed antidepressant
Please continue to 9099-C, Pg 2.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
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 5
Control Number 29-AS-20190910101511
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ABUNDANT CARE III
FACILITY NUMBER: 425801580
VISIT DATE: 07/29/2021
NARRATIVE
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medication; on 7/30/2019 R1 refused a psychiatric appointment scheduled by facility staff for R1 to encourage R1 to start taking Prozac again; on 8/17/2019 R1 refused psychiatric treatment; and on 8/21/2019 R1 refused psychiatric treatment. Even though R1 stated R1 did not want to resume taking Prozac, facility staff scheduled an appointment with R1’s physician for the purpose of resuming R1’s Prozac medication. Therefore, the allegation is Substantiated at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9009-D):

Exit interview conducted, today's reports and appeal rights were issued via email.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/10/2019 and conducted by Evaluator Kristin Kontilis
COMPLAINT CONTROL NUMBER: 29-AS-20190910101511

FACILITY NAME:ABUNDANT CARE IIIFACILITY NUMBER:
425801580
ADMINISTRATOR:DANIEL BONDFACILITY TYPE:
740
ADDRESS:4589 AUHAY DRIVETELEPHONE:
(805) 689-6900
CITY:SANTA BARBARASTATE: CAZIP CODE:
93110
CAPACITY:6CENSUS: DATE:
07/29/2021
UNANNOUNCEDTIME BEGAN:
10:53 AM
MET WITH:Timothy Pryko, AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility does not maintain accurate records of resident.
Facility threatens resident with eviction.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced complaint visit to the facility regarding the above allegations. During the investigation, LPA interviewed residents on 9/17/2019, 10/11/2019, and 2/15/2020, interviewed staff on 9/17/2019, 2/15/2020, and 2/23/2020; and interviewed credible witnesses on 9/17/2019 and 10/11/2019. LPA also collected and reviewed relevant documents on 9/17/2019, 10/11/2019, and 2/23/2020.
Allegation #1: Facility does not maintain accurate records of resident. It was alleged that Resident 1 (R1)’s physician’s report/medical assessment was incomplete and inaccurate. LPA reviewed two physician’s reports for R1, dated 07/12/2018 and 01/25/2019. LPA noted differences between the two reports, including the diagnoses, even though the two documents were signed by the same physician. No discrepancies were found in the completion of the report to indicate that the reports were altered. Based on the information obtained, the allegation is Unsubstantiated at this time.
Please continue to 9099-C, Pg 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20190910101511
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ABUNDANT CARE III
FACILITY NUMBER: 425801580
VISIT DATE: 07/29/2021
NARRATIVE
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Allegation #2: Facility threatens resident with eviction. R1 stated Administrator came into R1’s room and threatened R1 with eviction if R1 refused to resume taking R1’s Prozac medication. R1 stated Administrator responded to R1 saying ‘if R1 felt like R1 was being abused, R1 could go live somewhere else’. Facility staff denied threatening R1 with eviction. Although this allegation may have occurred, there is insufficient evidence to prove the allegation is true and correct. Therefore, the allegation is Unsubstantiated at this time.

Exit interview, report given. No deficiencies cited.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 29-AS-20190910101511
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ABUNDANT CARE III
FACILITY NUMBER: 425801580
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
07/30/2021
Section Cited
CCR
87468.1(a)(3)
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Personal Rights of Residents in All Facilities: To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature...
This requirement is not met as evidenced by:
Based on interviews conducted and documents reviewed, facility staff, including Administrator, used intimidation and a threat of eviction to
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Administrator agrees to submit a Statement of Understanding acknowledging full understanding of 87468.1 in its entirety. Administrator agrees to schedule and conduct an all-staff training with a qualified outside trainer to review 87468.1 in its entirety, including but not limited to: First/Last name of trainer(s), qualifications of trainer(s),
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try to make R1 resume a Prozac prescription which poses an immediate health and safety risk to residents in care.
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description of training, duration of training, attendees (printed first/last names and signature), and date training to be held. Scheduled training information will be sent to LPA no later than 7/30/2021 (end of business day).
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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: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5