Buena Vista Care Center
Buena Vista Care Center in Santa Barbara, CA — inspection on October 3, 2025.
Found 2 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
The facility failed to provide adequate supervision to prevent elopement while in the smoking area.
During an interview on 10/2/25 at 5:00 p.m. with the Director of Nursing (DON), the DON stated that the facility had seven residents currently using Wander Guard devices and confirmed the devices are checked weekly by nursing staff and not every night shift as ordered. DON acknowledged she was also unaware of the Wander Guard instructions for use indicating to have daily checks.During a review of the facility's Policy and Procedure (P&P) titled, Elopement Prevention/ Unsafe Wandering, dated 8/2025, the P&P indicated, If the Wander Guard system is used, it will be tested on a regular basis (time not specified) for proper functionality.During a review of the Wander Guard instructions for use (IFU's), the manufacture's guidance, dated 2023, the IFU's indicated that signaling devices are to be tested before use and tested daily thereafter, with results documented in the medical record.
Facility ID:
IDENTIFICATION NUMBER:
A.
Building
COMPLETED
10/03/2025
STREET ADDRESS, CITY, STATE, ZIP CODE
Buena Vista Care Center
160 South Patterson Avenue Santa Barbara, CA 93111
SUMMARY STATEMENT OF DEFICIENCIES
Based on observation, interview, and record review, the facility failed to perform daily functional testing of the Wander Guard system (an alert system worn on a resident's wrist that activates an audible alarm when passing doors equipped with sensors to prevent unsafe wandering) per manufacturer's instruction for use.This failure had the potential for seven residents using Wander Guard devices to elope from the facility without being detected.During the interview on 10/2/25 at 4:30 p.m. with licensed nurse (LN 2), LN 2 verified that Wander Guard devices are checked for functionality by nursing staff weekly every Thursday.
During an interview on 10/2/25 at 5:00 p.m. with Director of Nursing (DON), DON stated there are seven (7) residents using Wander Guard devices and confirmed that the devices were checked weekly and not checked daily with results documented in the medical record.During a review of Wander Guard instructions for use, dated 2023, indicated, the devices should be tested daily thereafter, with results documented in the medical record.
During the review of the facility's Policy and Procedure (P&P) titled, Elopement Prevention/ Unsafe Wandering, dated 8/2025, the P&P indicated, If the Wander Guard system is used, it will be tested on a regular basis (time not specified) for proper functionality.
Facility ID: