019200513-8-2-2023-15-AS-YFLS-CUPU5G-20230814151642

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200513
Report Date: 08/02/2023
Date Signed: 08/02/2023 03:02:49 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
07/24/2023 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20230724111330

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:	02:09 PM
MET WITH:	Anthony Garcia, Administrator		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Facility has pests.

INVESTIGATION FINDINGS:

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On 8/02/2023 at 2:00 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegation above. LPA met with Anthony Garcia, Administrator and explained the purpose of the visit.

During the course of investigation LPA interviewed the reporting party (RP), R1 and the facility administrator (ADM). LPA also toured Unit 115.

RP reported that his sister lives in Unit 115 has had bed bugs on and off for the past several months. Most recently his sister needed medical attention for the bed bug bites. Unit 115 is on the independent living side of the facility.

***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-20230724111330

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***

ADM stated that as soon as he was made of the situation (7/24/23) he and the facility maintenance director called Bay Area Bed Bugs, Orkin and several other companies. Orkin inspected the unit on 7/25/23 and responded with a proposal. ADM agreed to the proposal and the service was scheduled for 7/31/23. LPA received a copy of the Orkin invoice dated 7/31/23.

LPA interviewed R1 who stated that she is no longer being bitten. R1 sated “they killed them all.”

LPA toured Unit 115 and observed no evidence of bed bugs.

This agency has investigated the complaint alleging facility has pests we have found that the complaint was unsubstantiated. 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.

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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