019200513-11-21-2024-15-AS-KHOS-DCGSN4-20241231130056

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200513
Report Date: 11/21/2024
Date Signed: 11/21/2024 03:54:20 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
11/19/2024 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20241119125638

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: 109	DATE:	11/21/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Anthony Garcia, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not keep the facility free from cigarette odor

INVESTIGATION FINDINGS:

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On 11/21/2024 at 1:30 PM, Licensing Program Analyst (LPAs) Greg Clark and Ardalan Gharachorloo arrived unannounced to conduct an initial 10-day complaint investigation and to deliver findings in regard to the allegations above. LPA met with Executive Director, Anthony Garcia and explained the purpose of the visit.

During the course of the investigation, LPAs interviewed W1, facility staff and residents. LPAs also toured the independent living building at the facility.

S1 stated that the facility has a zero-tolerance policy regarding smoking on site and violation of that policy could result in eviction. LPAs observed a letter posted on the billboard in the independent living’s hallway. The letter stated that the community is a non-smoking community by order of the fire marshal. Individuals who feel the need to smoke need to do it outside of the property. “If this continues this will be considered a rule violation and dealt with accordingly and could lead to eviction”.

"CONTINUED ON LIC9099 C"

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: 11/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

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-20241119125638

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: 11/21/2024

NARRATIVE

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**REPORT CONTINUES FROM LIC 9099**

LPAs reviewed the letter dated 11/08/2024 that serves as a reminder to smoke off site. S1 stated that every residents received the letter on their doors.

LPAs interviewed S2 who stated that she suspects a resident on the first floor of the independent living building is lighting his cigarette as he is living the building which is a violation of the rule as he is not off site.

LPAs interviewed S3 who stated that she has never seen anybody smoking in the independent living building and she has never smelled smoke.

LPAs also interviewed R1 who stated that she has seen a resident who uses a scooter lighting up his cigarette as he finds his way off of the site. R1 further stated that she has never seen anybody smoking in the building.

This agency has investigated the complaint alleging staff did not keep the facility free from cigarette odor".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: 11/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

LIC9099 (FAS) - (06/04)

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