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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425801937
Report Date: 10/21/2025
Date Signed: 10/21/2025 06:05:00 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
09/03/2025 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20250903130423
FACILITY NAME:MARAVILLAFACILITY NUMBER:
425801937
ADMINISTRATOR:GRANDE, RUTH EFACILITY TYPE:
740
ADDRESS:5486 CALLE REALTELEPHONE:
(805) 967-1965
CITY:SANTA BARBARASTATE: CAZIP CODE:
93111
CAPACITY:131CENSUS: 105DATE:
10/21/2025
UNANNOUNCEDTIME BEGAN:
05:35 PM
MET WITH:Anna Munoz, Director of ALTIME COMPLETED:
06:10 PM
ALLEGATION(S):
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Staff did not seek medical attention for a resident in care.
Staff did not notify resident's responsible party of an incident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) De Leon conducted a subsequent complaint visit to the facility above. LPA met with Anna Munoz Director of Assisted Living and explained the purpose of the visit.


LPA Kontilis started the investigation on 09/05/2025. During the visit, LPA obtained documents, and conducted interviews with staff and residents from 11:47am to 3:30pm. LPA Kontilis conducted additional interviews by phone on 09/08/2025, and LPA De Leon conducted interviews by phone on 08/11/2025, 08/27/2025, and 10/14/2025.

On the allegation: Staff did not seek medical attention for a resident in care. It was alleged Resident 1 (R1) sustained a fall and did not get timely medical attention.

Continued 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
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-20250903130423
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: MARAVILLA
FACILITY NUMBER: 425801937
VISIT DATE: 10/21/2025
NARRATIVE
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On 08/31/2025 at approximately 9pm, R1 was assisted into bed by staff. R1 uses a wheelchair and requires staff assistance and a hoyer lift to be transferred into bed. R1 fell out of bed and was unable to reach their call pendant. R1 was found on the floor by staff the following morning, 09/01/2025. The staff was unable to lift R1 and obtained help from another staff. On 09/02/2025, R1’s responsible party indicated R1 complained of hip pain but the staff had not called 911 nor had R1 transported to the hospital. It was also noted R1 was on blood thinners.

R1’s responsible party stated a hospice nurse indicated the facility had not sent R1 to the hospital because they were on hospice and had a DNR. R1’s responsible party also stated R1 may have indicated they were fine, but they were previously disoriented due to a UTI and believes they should have been checked at a hospital. Staff interviewed indicated the facility contacts hospice to assess residents on hospice who are found on the floor or have a change in condition, unless the injury was very serious such as heavy bleeding or being unconscious, which would warrant a call to 911. LPA reviewed care notes for R1 that stated 09/01/2025 11:09pm, Alert Charting, resident found on floor. The charting states R1 used their pendant, and notes bruising and swelling to left hip, abrasion to left elbow and above left eyebrow; hospice and family called; placed on alert charting.

Interview with R1 revealed they do not remember how they got on the floor, or how long they were on the floor. R1 stated they could not reach their pendant, but a staff found them and assisted them. R1 stated they had a couple places with “severe pain,” including their hip, but did not know how to get pain pills. R1 stated a hospice nurse came over before 6am and examined them including range of motion tests with twisting and turning. R1 stated the hospice nurse determined there was no fracture and they would be ok until they can be re-evaluated as necessary by a doctor.

A facility nurse interviewed stated staff informed them of R1’s fall when they arrived on shift. The nurse stated once they went to R1’s room around 7am, the hospice nurse was already in the room examining R1. The nurse stated R1 stated he was not in any pain, but they did have injuries to their hip and head.

The staff who found R1 on the floor stated they responded to their call button around 4am, found them on the floor, and sought additional staff to help get R1 up. Staff stated they saw the left hip bruise, scratches to the forehead and a “rug burn” on the forehead, but R1 did not express any pain. Staff stated R1 was awake and talking to them, able to explain what they wanted, and said they were fine, therefore they called hospice instead of 911. Staff stated hospice arrived around 7am to assess the resident. Continued 9099-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20250903130423
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: MARAVILLA
FACILITY NUMBER: 425801937
VISIT DATE: 10/21/2025
NARRATIVE
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Administrator stated even if a resident is on hospice, they should have been sent to the hospital for any strike to the head. Administrator stated despite a resident being on hospice or despite a family requesting they not be sent out, a resident with a potential head injury should be sent out.
Based on the evidence this allegation is deemed Substantiated at this time.

On the allegation: Staff did not notify resident's responsible party of an incident.

It was alleged R1’s responsible party was not notified of R1’s fall that occurred overnight between 08/31/2025 and 09/01/2025.

R1’s responsible party indicated on 09/02/2025 they learned about the fall when they observed injuries on R1’s left side of face, above their eyes, on their arm and left hip.
R1’s responsible party indicated on a previous hospital visit for R1, the facility attempted to contact the responsible party but was trying to call phone numbers no longer in use, and had old addresses. After this, R1’s responsible party provided a letter with updated contact information for themselves as well as contact information for another responsible party for R1.

When interviewed, R1 stated no one contacted their responsible party to inform them of the fall.

The staff who found R1 on the floor stated they do not know who called R1’s responsible party to notify them, but believed the Med Aide was responsible for calling hospice and responsible parties. Med Aide stated they tried to call both responsible parties a few times and the call would not go through. Med Aide stated they called the two numbers on R1’s contact information, and informed the nurse at the end of their shift they had tried calling.
Administrator stated every year they send an email to responsible parties to ensure their contact information is up to date, and changes inputted get automatically updated in their system. Their system is accessible on a tablet that all care staff have access to, to ensure the most recent contact information is available. Staff interviewed indicated that sometimes families were not notified timely of incidents. Staff stated sometimes there is a breakdown in communication where they leave a voicemail, but after a shift change, the calls or follow ups are not always completed. Staff interviewed indicated manual updates for resident information do not get updated timely, mostly due to the facility being short staffed and focusing on other priorities.
Continued 9099-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20250903130423
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: MARAVILLA
FACILITY NUMBER: 425801937
VISIT DATE: 10/21/2025
NARRATIVE
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A responsible party for another resident was interviewed and indicated they had also not received notifications from staff for two falls a resident had sustained.

LPA reviewed care notes for R1 that stated 09/01/2025 hospice and family were called due to the fall. The incident report submitted by the facility for the fall states on 09/01/2025 at 5:45am, notification was attempted to contact one of R1’s responsible parties, it states “no answer” and “did not leave a voice message.”

Based on the evidence this allegation is deemed Substantiated at this time.

Exit interview conducted, deficiencies cited, copy of report and appeal rights printed.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20250903130423
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: MARAVILLA
FACILITY NUMBER: 425801937
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/28/2025
Section Cited
CCR
87465(a)(2
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87465(a)(2) The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the resident's need. This requirement was not met as evidenced by:
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Representative agrees to review facility procedures for seeking timely medical attention and hold a training with all staff.
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Based on interview and record review, the licensee did not comply with the section cited when they did not seek timely and appropriate medical attention for R1, which posed a potential health and safety risk to residents in care.
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Type B
10/28/2025
Section Cited
CCR
87468.1(a)(8)
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(8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs.
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Representative agrees to review facility procedures for updating contact information timely and procedures for notifying responsible parties timely. Representative agrees to hold a training with all staff on the updated procedures
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Based on interview and record review, the licensee did not comply with the section cited when they did not inform R1’s responsible party of a fall with injury, which posed a potential health, safety and personal rights risk to residents in care.
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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: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5