019200513-8-2-2023-15-AS-YFLS-CUPUC2-20230814152714

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200513
Report Date: 08/02/2023
Date Signed: 08/02/2023 03:59:34 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/03/2023 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20230703094609

FACILITY NAME:	PACIFICA SENIOR LIVING OAKLAND		FACILITY NUMBER:	019200513
ADMINISTRATOR:	GARCIA, ANTHONY		FACILITY TYPE:	740
ADDRESS:	2330, 2350, 2361 E 29TH ST		TELEPHONE:	(510) 534-3637
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94606
CAPACITY:	197	CENSUS: 102	DATE:	08/02/2023
		UNANNOUNCED	TIME BEGAN:	03:10 PM
MET WITH:	Anthony Garcia, Administrator		TIME COMPLETED:	04:07 PM

ALLEGATION(S):

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Staff did not ensure that facility garage gate is operational.
Staff did not ensure that resident's original residence has been fixed since it was flooded over 6 months ago.
Staff did not ensure that facility front gate is operational.

INVESTIGATION FINDINGS:

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On 8/02/23 3:10 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver findings for the above allegations. LPA met with Anthony Garcia, Administrator (ADM) and explained the purpose of the visit.

On 7/13/23 LPA interviewed the ADM and R1. LPA received a copy of the repair order for the front gate from R&S Overhead Garage Door, Inc. dated 7/10/23. LPA also toured R1's apartments 102 and 117.

LPA has investigated all of the allegations as follows:

Staff did not ensure that facility garage gate is operational.
ADM stated that the gate to the garage is sometimes put in a “locked open” status for deliveries. LPA observed that the gate is operational on today’s visit.
***report continues on LIC9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory Clark	TELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20230703094609

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: PACIFICA SENIOR LIVING OAKLAND	FACILITY NUMBER: 019200513
	VISIT DATE: 08/02/2023

NARRATIVE

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***report continues from LIC9099***

Staff did not ensure that resident's original residence has been fixed since it was flooded over 6 months ago.

R1 lived in SW102. R1’s kitchen was flooded in 10/2022. Roto Rooter was called but issue wasn’t resolved, and the kitchen keep flooding. R1 was moved to a larger apartment (SW117) down the hall from her former residence. During December 2022 and January 2023, the facility was trying to get Roto Rooter to take responsibility for the damage they did to the plumbing in the kitchen of SW102. During February and March 2023, the facility was getting bids for the needed repairs which were extensive. In April 2023 the plumbing under the kitchen floor was repaired. During May 2023 the facility again was getting bids to re-model the kitchen. A contractor was chosen in July 2023 and the scope of work is being finalized. Re-model work has started and currently a new floor is being installed.

LPA interviewed R1 at the facility. R1 stated that there are a few things she doesn’t like about her current apartment but that she is “making do.” R1 is happy that she can go back to her old apartment several times a week to take care of her plants. R1 further stated that she is confident that the facility staff are working hard to get her back into her apartment.

Staff did not ensure that facility front gate is operational.

R&S Overhead Garage Door Company repaired the front gate on 7/20/23. LPA observed the gate to be operational during today’s visit.

This agency has investigated the complaints alleging staff did not ensure that facility garage gate is operational, staff did not ensure that resident's original residence has been fixed since it was flooded over 6 months ago, and staff did not ensure that facility main gate is operational. We have found that the allegations are unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory Clark	TELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

LIC9099 (FAS) - (06/04)

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