<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200513
Report Date: 11/24/2025
Date Signed: 11/24/2025 02:50:53 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
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240228122658
FACILITY NAME:PACIFICA SENIOR LIVING OAKLANDFACILITY NUMBER:
019200513
ADMINISTRATOR:GARCIA, ANTHONYFACILITY TYPE:
740
ADDRESS:2330, 2350, 2361 E 29TH STTELEPHONE:
(510) 534-3637
CITY:OAKLANDSTATE: CAZIP CODE:
94606
CAPACITY:197CENSUS: 99DATE:
11/24/2025
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH: Anthony Garcia, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not abiding to the admission agreement
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This is an amended report. On 11/24/25 at 2:15 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver an amended report and findings in regard to the allegation 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. The Department reviewed the facility’s bed bug addendum to the admission agreement. LPA also toured R1’s apartment.

The facility’s admission agreement dated December 2019 does not state that it is the resident’s responsibility to pay to keep the facility free from pests (i.e.: bed bugs). 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. It wasn’t until sometime in late January early February 2024 that the facility provided R1 the bed bug addendum.
***report continues on LIC9099***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
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: 11/24/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
***report continues from LIC9099***

R1 was told by S1 that they needed to sign an addendum to the admissions agreement to pay for the bed bug treatment or their lease would be terminated. R1 signed the addendum on 3/1/24 and hired a pest control company on 3/7/24 to treat the bug beds in their apartment.

The Bed Bug Addendum stipulates that residents are responsible for paying for any bed bug treatment. Residents have a right to be accorded safe, healthful, and comfortable accommodations under HSC Code §1569.269(a)(5) and 22 CCR §87468.1(a)(2). Facilities must be maintained in clean, safe, sanitary conditions under 22 CCR 87303(a). Therefore, it is the facility’s responsibility to ensure that residents are provided with safe, healthful, and comfortable accommodations. This includes maintaining the facility in a clean, safe, and sanitary condition, which encompasses pest control and bed bug eradication. This cost cannot be transferred to the residents in care.

This agency has investigated the complaint alleging that the staff are not abiding to the admission agreement. Based on interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Health and Safety Code of Code of Regulations (Chapter 3.2 Article 2.5), are being cited on the attached LIC 9099D.

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

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
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: 11/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/05/2025
Section Cited
HSC
1569.269(a)(5)
1
2
3
4
5
6
7
Enumerated rights: (a) Residents of residential care facilities for the elderly shall have all of the following rights:
(5) To be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment.
1
2
3
4
5
6
7
Licensee to send a notice to all residents notifying them of the removal of the bed bug addendum, licensee to reimburse any residents for costs of bed bug treatments and send letter of self-attestation of completion to LPA by POC date.
8
9
10
11
12
13
14
Based on record review the licensee did not comply with the section cited above. Licensee added a bed bug addendum to the admissions agreement requiring residents to pay for bed bug eradication, which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3