Oak Cottage Of Santa Barbara Memory Care

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Staff violated resident's personal rights.

Licensing Program Analyst (LPA) Kristin Kontilis conducted a subsequent complaint visit to issue final findings on this investigation. LPA met with Administrator Tyler Barnes and explained the purpose of the visit. During the investigation, LPA conducted an initial visit on 9/10/2024 from 1:45 pm to 5:00 pm, where LPA interviewed staff and residents and requested documents. Additional interviews were conducted on 9/5/2024 and 5/27/2025. LPA conducted additional staff interviews on 11/18/2025 from 11:40 am to 4:00 pm and 11/19/2025 from 1:45 pm to 2:00 pm. On the allegation: Staff violated resident's personal rights. It was alleged Resident 2 (R2), who verbally expresses themselves with limited and few words and is wheelchair-bound, is placed in a corner away from other residents with their brakes locked so they cannot leave. It was alleged that this is a form of restraint, and R2’s wheelchair has caused damage to the surrounding walls, suggesting this is a common practice. Please contithe state’s words, verbatim · CDSS document, Nov 19, 2025 · control 29-AS-20240904153809

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Facility staff did not provide adequate supervision to residents in care. Illegal eviction. Facility staff did not properly report abuse.

Licensing Program Analyst (LPA) Kristin Kontilis conducted an initial complaint visit for this investigation. During today’s visit, LPA met with Tyler Barnes, Administrator, and explained the purpose of the visit. LPA toured the facility, interviewed staff, and obtained relevant documents. On the allegation: Facility staff did not provide adequate supervision to residents in care. R1 was admitted into the facility for respite care on 8/20/2024. Based on R1’s aggressive behaviors, the need for a one-on-one private caregiver for R1 was implemented at the time of admission on 8/20/2024. CCL received incident reports from the facility reporting aggression from R1 on 8/26/2024, 8/27/2024, and 8/29/2024. Based on the incident report and interviews conducted, on 8/29/2024 at approximately 4:45 pm, R1 and R2, both of whom had private one-on-one caregivers, were in the elevator. When the elevator door opened, R1 grabbed R2’s hair, and walked R2 out of the elevator into the activity room while kthe state’s words, verbatim · CDSS document, Sep 24, 2024 · control 29-AS-20240917144445

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Staff did not provide adequate supervision to a resident.

Licensing Program Analyst (LPA) Kristin Kontilis conducted an initial 10-Day complaint visit on the above-stated allegation. LPA met with Jovany Guerra, Senior Resident Care Director (SRCD) and announced the purpose of the visit. At the time of arrival Administrator Andrea Katz was not available. During today’s visit, from 12:00 pm to 4:00 pm, LPA conducted interviews and obtained documents pertinent to the investigation. On the allegation, Staff did not provide adequate care and supervision to a resident: It was alleged that lack of supervision resulted in R1 eloping from the facility on 2/10/2023. Information gathered reflected that R1 has a diagnosis of Dementia and was admitted into the facility on 9/22/2021. Interviews conducted and records reviewed revealed that R1 eloped from the facility at approximately 1:01 am on 2/10/2023. Interviews further reflected that 9-1-1 was called by facility staff to alert emergency responders to assist in a perimeter search for R1. Jovany Guerra,the state’s words, verbatim · CDSS document, Jan 12, 2024 · control 29-AS-20240108210433

Allegation investigated: Staff did not meet resident's diapering needs Staff did not adequately manage resident's medication

Licensing Program Analyst (LPA) Kontilis conducted a subsequent complaint visit to issue final findings for the complaint allegations above. LPA met with Jovany Guerra, Senior Resident Care Director and explained the purpose of the visit. During the investigation, LPA reviewed relevant documents, and conducted interviews with responsible parties on 9/16/2021 and 10/4/2021, and staff on 12/18/2023. On the allegation: Staff did not meet resident's diapering needs. It was alleged that R1 was wearing two briefs, with the first brief soiled. R1’s responsible party confirmed on one occasion, they observed R1 wearing two briefs. Staff interviewed stated they were aware of other staff double diapering residents in the past. Facility nurse confirmed double diapering is against the facility’s policy, and around the time of this complaint they became aware that a caregiver double diapered residents at the facility. Facility nurse stated they held an in-service training with all staff to address tthe state’s words, verbatim · CDSS document, Dec 20, 2023 · control 29-AS-20211013143424