425850025-3-10-2022-29-AS-KBUY-CCEVDM-20220311152059

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850025
Report Date: 03/10/2022
Date Signed: 03/10/2022 03:16:19 PM

Unsubstantiated

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
11/02/2020 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20201102131546

FACILITY NAME:	SANTA MARIA TERRACE		FACILITY NUMBER:	425850025
ADMINISTRATOR:	ENRIQUEZ, SANJUANA		FACILITY TYPE:	740
ADDRESS:	1405 E MAIN ST		TELEPHONE:	(805) 925-8713
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY:	140	CENSUS:	DATE:	03/10/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:			TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility is not following its Admission Agreement on refunds
Facility staff did not keep residents’ room clean

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson and Licensing Program Manager (LPM) Burley conducted an unannounced complaint visit to issue final findings. LPA Diaz conducted the investigation, reviewed facility documents and conducted interviews with staff and residents. LPA interviewed clients on 08/28/2021 at 2:57pm, 3:06pm, 3:14pm, 3:20pm, 3:31pm, 3:37pm, and 3:50pm. LPA interviewed staff on 8/22/21 at 5:38pm, and 8:23pm at 6:07pm. LPA interviewed staff on 8/24/21 at 8:34am, 2:38pm, 3:21pm and on 8/2821 at 2:13pm. LPA reviewed R1’s admission agreement, physician’s report, preadmission appraisal, assessment, care plan, and ledgers provided. LPA Olson intervied 2 staff on 3/10/22 and reviewed records.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

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 3

Control Number 29-AS-20201102131546

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: SANTA MARIA TERRACE	FACILITY NUMBER: 425850025
	VISIT DATE: 03/10/2022

NARRATIVE

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On the allegation: Facility is not following its Admissions agreement on refunds. It was alleged that Resident 1 (R1) was overcharged for bathing and medication assistance, and was overcharged for a month of care before moving out. 7 out of 7 residents stated that they have no issues receiving services at the facility or do they have problems with refunds. 2 residents stated that they requested the facility to remove specific services that they no longer need, and the facility complied with their requests. R1’s physician’s report dated 3/21/2019 indicates R1 can self-bathe when R1’s pain is controlled, and can handle their own medications except if using excess pain medication. R1’s pre-admission appraisal indicates standby assistance for showers and facility will store, manage and help with self-administration of medications and was signed by R1 on 4/16/2019. R1’s assessment indicates stand by assistance with bathing every other day, and for staff assistance with medication, and was signed by R1 on 4/16/2019. R1’s care plan indicates R1 needed physical assistance with bathing twice weekly and for staff assistance with medication. Although R1 refused staff assistance with bathing on multiple occasions, the Administrator stated R1 still needed assistance with bathing due to R1’s physician’s report and care plan, which was agreed to by R1. The Administrator stated the safest way for R1 to shower was with staff assistance. The Administrator stated R1 typically would not shower unless staff assisted R1 with it, despite claims R1 had already showered. R1 refused bathing assistance in July and August 2019 but was still charged for it, because R1’s physician indicated R1 needed assistance with bathing and R1 signed their care plan agreeing to shower assistance.
R1 was charged for medication assistance in November and December 2019. The Administrator stated when a resident is in the hospital, they stop charges for care but they still charge for medication management because the resident still has medications at the facility even if they are PRN medications. The Administrator stated the staff still count the medications including PRNs everyday, and so therefore still charge for medication assistance unless the resident does not have any medications present in the facility. This is also stated in the admission agreement on page 8 under “Absence from the Community.” R1 and their responsible party both signed the admission agreement on 4/19/2019.
R1 was moved from the facility in September 2020 and provided a written 30-day notice on 9/25/2020. R1’s belongings were removed by 9/28/2020. The September 2020 fees were already paid on 9/10/2020, before R1 moved out. The October 2020 fee consisted of a pro-rated room rate only, since no care was provided in October. LPA reviewed the records and determined the facility did not charge for anything after the 30-day notice was up. Based on the information obtained, the allegations are deemed unsubstantiated at this time.

Continued on 9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20201102131546

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: SANTA MARIA TERRACE	FACILITY NUMBER: 425850025
	VISIT DATE: 03/10/2022

NARRATIVE

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On the allegation: Facility staff did not keep residents’ room clean. 7 out of 7 residents stated that the facility is kept clean by the caregivers and housekeepers. The residents stated staff dust, sweep, mop, vacuum floors, wash bed sheets, remove trash, and help organize resident’s rooms. The resident’s laundry and the resident’s rooms are cleaned once a week. The residents also stated that the bed sheets smell good after they are cleaned. The staff are frequently cleaning, and all residents interviewed are satisfied with the cleanliness at the facility. According to the staff, caregivers would make beds, clean counter tops, sweep, dust, take out the trash, and clean up accidents. The housekeepers are required perform deep cleanings and use liquid cleaners to clean toilets. The staff confirmed that housekeeping and laundry is done once a week but will also clean rooms if messes occur. According to the staff, R1 would refuse housekeeping and therefore staff would often monitor R1’s room and clean spilt food or old food that was left out. R1 would sleep without R1’s briefs and therefore housekeeping was frequently changing sheets to prevent odors. According to the staff, the housekeepers do a good job and none of the residents have said there are unsatisfied with cleanliness in the facility. LPA observed several different resident rooms to be clean and sanitary. Based on the interviews and observations, the allegation is deemed unsubstantiated at this time.
Exit interview, report given.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022

LIC9099 (FAS) - (06/04)

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