019200513-11-8-2024-15-AS-YFLS-DBCV6S-20241125151002

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200513
Report Date: 11/08/2024
Date Signed: 11/08/2024 01:32:10 PM

Substantiated

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
02/28/2024 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20240228122658

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: 111	DATE:	11/08/2024
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Anthony Garcia, Administrator		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff did not keep the facility free from pest infestation
Staff threatened the residents with eviction

INVESTIGATION FINDINGS:

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On 11/08/24 at 12:45 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver findings in regard to the allegations above. LPA met with Anthony Garcia, Administrator and explained the purpose of the visit.

During the course of the investigation LPA interviewed the reporting Party (RP), S1, and R1. LPA also toured R1’s apartment.

R1 has lived at the facility for over 5 years. R1 stated to LPA that there has been a chronic problem with bed bugs in her apartment “for years.” She also stated that she felt the facility management was making efforts to eradicate the problem, but it has persisted. Recently however she has not been pleased with facility management. She feels pressured to now pay for the bed bug treatment or “get kicked out.”

***report continues on LIC9099C***

Substantiated

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: 11/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024

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-20240228122658

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: 11/08/2024

NARRATIVE

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***report continues from LIC9099***

Allegation: Staff did not keep the facility free from pest infestation

The RP stated that for the third time in a year R1’s apartment at the facility is infested with bed bugs. LPA interviewed S1 who confirmed that the apartment in question had in fact been infested with bed bugs numerous times over the past year and that treatments from the pest control company work for a time, but the bed bugs return. R1 also confirmed that the bed bugs continue to be an issue.

Allegation: Staff threatened the residents with eviction

RP reported that residents at the facility were forced to sign an admission agreement addendum stating that all treatments for bed bugs would be paid for by the residents and that if the residents did not sign the addendum their lease would be terminated. S1 confirmed that the bed bug addendum to the admissions agreement started getting rolled out in 2020 and is now part of the facility’s standard admissions agreement. S1 further stated that residents were required to sign the addendum or face eviction. R1 stated that she signed the bed bug addendum because she was getting too stressed out by facing possible eviction. An email sent to the RP from S1 stated, "…the addendum we are asking to have signed has been a part of our leases since 2020. We are requiring all resident (sic) to sign it. It is a condition of R1 staying in the community.”

Based on LPA observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.

Exit interview conducted, a copy of this report and appeal rights provided.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory Clark	TELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20240228122658

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/08/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/15/2024 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees, and visitors.	1 2 3 4 5 6 7	Facility administrator shall develop a plan for routine maintenance, including checks for bed bugs, and submit to CCL by POC date. LPA also requests all bed bug reports for R1's Apartment be sent to LPA by POC date.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by the facility did not ensure the R1’s apartment was kept free of bed bugs.	8 9 10 11 12 13 14
Type B 11/15/2024 Section Cited CCR 87468.1	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature,	1 2 3 4 5 6 7	Facility to conduct a Residents Rights training by POC date and submit proof to CCL by POC date.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by the facility threatening R1 with eviction if they did not sign the addendum to the admission agreement.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory Clark	TELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024

LIC9099 (FAS) - (06/04)

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