019200513-3-27-2025-15-AS-KHOS-DFXK77-20250421073839

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200513
Report Date: 03/27/2025
Date Signed: 03/27/2025 03:50:46 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
03/19/2025 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20250319085620

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: 100	DATE:	03/27/2025
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Anthony Garcia, Executive Director		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Unlawful eviction
Facility did not provide comfortable temperature
Facility staff is retaliating against the resident

INVESTIGATION FINDINGS:

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On 3/27/25 at 2:15 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 allegations above. LPA met with Anthony Garcia, Executive Director and explained the purpose of the visit.

During the course of the investigation LPA interviewed W1, S1 and S2 and toured the facility’s memory care unit and reveiwed documents related to R1's balance ledger.

Allegation: Unlawful eviction
S1 and S2 stated that R1 moved into the facility’s memory care unit on 9/10/24 from Kaiser Hospital Oakland’s Emergency Department. Kaiser agreed to pay R1’s first month’s rent and Community Fee. S2 stated that she offered to help W1 find a contact at Kaiser who could authorize payment. To date Kaiser has not paid the outstanding balance. The facility issued a 30-day Notice to Quit to R1 and W1 per company policy.
***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: 03/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025

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-20250319085620

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: 03/27/2025

NARRATIVE

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***report continues from LIC9099***

Allegation: Facility did not provide comfortable temperature

S1 stated that from time to time the thermostats in the Memory Care Unit need maintenance to operate properly. Upon notice of an issue S1 calls a HVAC company and they come out with-in a day or two to address the issue. LPA toured the memory care unit and found that the temperature in the unit was at a proper level and the residents all looked comfortable.

Allegation: Facility staff is retaliating against the resident

LPA found that there is no evidence to support this allegation. LPA observed R1 to be comfortable in the Memory Care Unit dressed in sweats and a black hoodie. LPA also could not find any evidence of any complaints filed regarding R1.

This agency has investigated the complaint alleging: Unlawful eviction, facility did not provide comfortable temperature and facility staff is retaliating against the resident. We have found that the complaints were unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations 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: 03/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025

LIC9099 (FAS) - (06/04)

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