Inspection Reports for Garden Court at Villa Santa Barbara

The visit was an Informal Conference held to discuss complaint investigation 29-AS-20241001130402 regarding a resident's injury due to alleged staff failure to respond to a call button in a timely manner, along with a general compliance review of the facility.

The investigation revealed that staff did not respond to Resident 1's call for assistance, resulting in the resident falling and sustaining a facial laceration, hematoma, and wrist fracture. The licensee representatives discussed measures implemented to maintain compliance and address the resident's needs, including additional monitoring, staff training, and system oversight. A potential civil penalty of $10,000 for serious bodily injury is under review.

Complaint alleged that facility staff did not answer Resident 1's call button in a timely manner, resulting in the resident sustaining a fracture, facial laceration, and hematoma. Investigation confirmed staff failure to respond, leading to serious bodily injury.

An unannounced required Annual Inspection was conducted to evaluate compliance with licensing regulations for the Residential Care Facility for the Elderly (RCFE).

The inspection revealed medication administration discrepancies for Resident 1, including under-administration of Senna and an extra dose of Acyclovir. Deficiencies were cited related to medication management and a plan of correction was required.

The visit was an unannounced complaint investigation triggered by allegations received on 2023-09-18 regarding staff not assisting residents with incontinence needs, failure to keep the facility free of odor, and a resident developing a pressure injury while in care.

After multiple visits, interviews, and document reviews, the allegations were found to be unsubstantiated due to insufficient evidence. Staff were found to be responsive to residents' needs, no foul odors were confirmed, and the alleged pressure injury was determined to be moisture-associated skin damage that had healed.

The complaint investigation was unsubstantiated. Allegations included failure to assist with incontinence, facility odor issues, and a pressure injury. Investigations included interviews with staff, residents, visitors, hospice personnel, and review of documentation. The pressure injury was identified as moisture-associated skin damage, not a pressure ulcer.

The visit was an unannounced complaint investigation triggered by an allegation that facility staff did not meet a resident's needs, specifically concerning pressure injuries sustained by Resident 1 (R1).

The investigation found insufficient evidence to substantiate the allegation that facility staff failed to meet R1's needs. Medical and hospice records did not confirm any pressure injuries or wounds, and staff provided appropriate care. The allegation was deemed unsubstantiated.

The complaint alleged that facility staff did not meet Resident 1's needs, including concerns about pressure injuries. The investigation included interviews, document reviews, and observations. The allegation was unsubstantiated due to lack of evidence of pressure injuries or wounds in hospital and hospice records.

The visit was an unannounced Case Management site visit conducted to follow up on an immediate exclusion served to Staff #1 (S1) and to confirm removal of the excluded staff member from the facility.

The Administrator confirmed that Staff #1 has not worked at the facility since 4/22/2018 and that the staff member was not present during the visit. No citations were issued during the visit.

An unannounced required Annual Inspection was conducted to evaluate compliance with licensing requirements for the Residential Care Facility for the Elderly (RCFE).

The inspection revealed medication management deficiencies including unexplainable overcounts of medications for Resident 1 and the presence of eight expired medications. Plans of correction were required to address these issues by 02/29/2024.

The inspection was an unannounced complaint investigation visit triggered by an allegation that staff were refusing to allow a resident to remove their personal belongings from the facility.

The investigation found that the allegation was unsubstantiated. The Administrator and Wellness Director confirmed that the resident was responsible for themselves with no POA or Responsible Party on file, and after communication with the resident's family, the resident's belongings were eventually removed from the facility.

The complaint alleged that staff refused to allow a resident to remove their personal belongings. The investigation included interviews and document reviews, concluding the allegation was unsubstantiated.

The inspection was an unannounced complaint investigation visit triggered by an allegation that staff do not answer residents' call buttons in a timely manner.

The allegation that staff did not respond to a resident's call pendant in a timely manner was substantiated. Records showed call responses took between 10-29 minutes, exceeding the facility's goal of 3-5 minutes, posing an immediate health and safety risk.

The complaint was substantiated based on interviews, record review, and observation. The resident's call pendant was pressed multiple times with delayed responses of 10-29 minutes, which posed an immediate health and safety risk.

Unannounced complaint investigation visit conducted in response to allegations that staff spoke inappropriately towards residents and did not treat residents with dignity.

The investigation included interviews with residents, staff, and administrators. Evidence did not substantiate the allegations; residents reported being happy with staff and no inappropriate behavior was confirmed. An all-staff in-service training was conducted to reinforce residents' rights and staff interaction expectations.

The complaint alleged staff spoke rudely and inappropriately to residents, including a staff member (S1) using a yelling tone. Interviews and investigation found no substantiation of these claims. The allegation was determined to be unsubstantiated.

An announced Change of Ownership Prelicensing Inspection was conducted to license the facility as a Residential Care Facility for the Elderly (RCFE).

The facility was found to be in good repair, clean, and compliant with licensing requirements per Title 22 California Code of Regulations. Fire safety and personal accommodations were inspected with no deficiencies noted.