019200513-12-20-2023-15-AS-KHOS-CZ5Q69-20240103105311

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200513
Report Date: 12/20/2023
Date Signed: 12/20/2023 02:28:15 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
12/12/2023 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20231212163336

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: 107	DATE:	12/20/2023
		UNANNOUNCED	TIME BEGAN:	01:46 PM
MET WITH:	Anthony Garcia, Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Illegal eviction

INVESTIGATION FINDINGS:

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On 12/20/23 1:45 p.m. Licensing Program Analyst (LPA) Greg Clark conducted an unannounced visit to conduct an initial 10 day complaint investigation and deliver findings for the above allegation. LPA met with Anthony Garcia, Administrator and explained the purpose of the visit.

During the course of investigation, LPA interviewed S1 and reviewed R1's eviction notice and payment ledger.

LPA’s interview with S1 revealed that at the time when the "notice to quit" was issued (8/16/23) R1's power of attorney (POA) was his son. LPA reviewed the certified mail receipt sent to the POA at his address in Texas, it was never returned. LPA also reviewed the Notice to Quit, and it meets regulatory guidelines. As of 8/16/23 the facility had not received payment for rent for several months and R1 owed the facility $76.233.65.

***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: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

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-20231212163336

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: 12/20/2023

NARRATIVE

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***report continues from LIC9099***

On 9/08/23 R1’s POA was changed via court order to a public guardian. The public guardian is currently working with the facility to arrange payment of back rent and the “Notice to Quit” is on hold.

This agency has investigated the complaint alleging illegal eviction. 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: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

LIC9099 (FAS) - (06/04)

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