<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425850025
Report Date: 10/01/2024
Date Signed: 10/01/2024 12:04:27 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/09/2024 and conducted by Evaluator Erika Miller
COMPLAINT CONTROL NUMBER: 29-AS-20240809092613
FACILITY NAME:SANTA MARIA TERRACEFACILITY NUMBER:
425850025
ADMINISTRATOR:ENRIQUEZ, SANJUANAFACILITY TYPE:
740
ADDRESS:1405 E MAIN STTELEPHONE:
(805) 925-8713
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:140CENSUS: 90DATE:
10/01/2024
UNANNOUNCEDTIME BEGAN:
11:07 AM
MET WITH:Amy Bowman, Wellness DirectorTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not provide medication to resident for pain management
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Erika Miller (Miller) conducted an unannounced complaint visit on 10/1/24 to issue final findings on the allegations above. During the investigation, LPA, Miller, toured the facility and interviewed staff on August 16, 2024, from 10:49 a.m. to 1:00 p.m. LPA also obtained and reviewed relevant documents. LPA met with Joanna Enriquez, Administrator and Amy Bowman (Bowman), Wellness Director, to explain the purpose of the visit.

On the allegation: Facility staff did not provide medication to resident for pain management. It was alleged by Reporting Party (RP) that on August 8, 2024, they observed that Resident 1(R1) was complaining of pain in her neck, spine, and leg. RP states they advised a Staff and expressed concern for the R1’s pain. It was alleged that the staff did nothing to help R1 with pain management. Bowman stated that the facility does not deny pain medication to residents in pain. Bowman further stated that staff may not provide pain medication, outside the pain management window. (Continued on 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Erika Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
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-20240809092613
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SANTA MARIA TERRACE
FACILITY NUMBER: 425850025
VISIT DATE: 10/01/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
There may also be instances, that staff could ask a resident if they could wait until the next pain medication window. When a resident cannot wait, staff will contact hospice for direction on administering breakthrough pain medication. Facility policy is to review the electronic MAR to ensure an additional dose is permissible. Bowman stated that if a Med Tech is advised that a resident is in pain, they would typically speak to resident and follow policy. On August 8, 2024, newly hired Med Techs were in training and may not have known how to explain pain management procedures and policies.

A request for copy of July and August e-MAR was made on 9/20/24 via email. LPA reviewed the MAR for R1 and observed that PRNs for pain were given during the months of July and August 2024.

Bowman advised LPA that R1 is to receive Norco 4 times a day routinely as needed. R1 also has a comfort kit consisting of Lorazepam and Morphine to be used at the time of her passing. LPA reviewed physician’s report that states R1 to avoid aspirin and NSAIDS.

LPA interviewed R1 about their pain management. R1 stated they were in pain yesterday and the day before they were not. R1 stated, “I’m feeling so lousy”. R1 stated that there are days Staff provide medication for pain and on other days Staff will not provide medication for pain. R1 visibly confused. R1 could not recall if they had eaten that day and made various statements; “I’m ready to leave, I’m hanging, I’m ready to give up, I’m so tired of it now, I’m 96 and I’m at the very end of my rope”. At the time of this report, R1 has passed away.

Although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Erika Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/09/2024 and conducted by Evaluator Erika Miller
COMPLAINT CONTROL NUMBER: 29-AS-20240809092613

FACILITY NAME:SANTA MARIA TERRACEFACILITY NUMBER:
425850025
ADMINISTRATOR:ENRIQUEZ, SANJUANAFACILITY TYPE:
740
ADDRESS:1405 E MAIN STTELEPHONE:
(805) 925-8713
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:140CENSUS: 90DATE:
10/01/2024
UNANNOUNCEDTIME BEGAN:
11:07 AM
MET WITH:Amy Bowman, Wellness DirectorTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff are not providing adequate assistance to resident during meal time
Staff are not repositioning resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On the allegations: Facility staff are not providing adequate assistance to resident during mealtime and staff are not repositioning resident.

It was alleged that R1 cannot feed self and should be fed by staff, but food was delivered to R1, which posed a choking hazard. LPA reviewed R1’s physician’s report dated 7/30/24 and care plan, which indicates that R1 is not able to feed self. Staff 1 (S1) identified R1 as someone that needs assistance eating their meals and will assist R1 eat, if R1 is noticeably weak. S1 stated that when they deliver R1’s food tray and is assigned to R1 they will feed R1. S1 stated that they are aware of an incident that occurred on 8/8/24 in R1’s room. On 8/8/24, Staff 2 (S2), was assigned to R1s room. A Hospice Nurse observed a S2 sitting in room, while R1 was hunched over in bed and unable to reach the meal tray. Staff 1 stated that Hospice Nurse directed S2 to help R1 sit up and have her meal. S2 employment was subsequently terminated. (Continued on 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Erika Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20240809092613
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SANTA MARIA TERRACE
FACILITY NUMBER: 425850025
VISIT DATE: 10/01/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA interviewed R1 about their experience with staff assistance during meals. R1 was unable to provide any insight into LPA questions.

It was alleged staff did not reposition R1 in their bed during mealtime. LPA reviewed R1’s physician’s report and care plan, which indicates R1 is non-ambulatory and has motor impairment and paralysis. LPA observed R1 was able to slightly adjust themselves in bed and from LPA observation it was clear that R1 required additional assistance.

Bowman described a separate incident on 8/8/24. S2 entered R2’s bedroom and advised they were not trained and did not know how to change and reposition resident. R2’s daughter was present and notified Bowman of the incident. Bowman stated that this was not the first instance of S2’s failure to perform duties. S2 was terminated effective 8/12/24. Based on the multiple accounts by multiple staff, it is reasonable to believe that a staff member was not repositioning residents and was ultimately terminated.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) are found to be SUBSTANTIATED. California Code of Regulations are being cited on the attached LIC 9099D.


Exit interview conducted, copy of report issued.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Erika Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20240809092613
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SANTA MARIA TERRACE
FACILITY NUMBER: 425850025
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/01/2024
Section Cited
CCR
87468.2
1
2
3
4
5
6
7
Additional Personal Rights of Residents ... in privately operated residential care facilities... shall have... care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
1
2
3
4
5
6
7
Licensee agreed to ensure staff are adequately trained and will continue to conduct 30-day performance reviews to determine if additional training is needed and such training will be completed within a 90-day window.
8
9
10
11
12
13
14
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Erika Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5