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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107202497
Report Date: 02/04/2022
Date Signed: 02/11/2022 12:38:24 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/18/2022 and conducted by Evaluator Alexandria Walton
COMPLAINT CONTROL NUMBER: 24-AS-20220118084744
FACILITY NAME:PACIFICA SENIOR LIVING FRESNOFACILITY NUMBER:
107202497
ADMINISTRATOR:NATASHA HAGOPIANFACILITY TYPE:
740
ADDRESS:1715 E ALLUVIAL AVETELEPHONE:
(559) 298-4900
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:100CENSUS: 78DATE:
02/04/2022
UNANNOUNCEDTIME BEGAN:
02:59 PM
MET WITH:Administrator, Eddie RangelTIME COMPLETED:
03:11 PM
ALLEGATION(S):
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Facility does not communicate with responsible party regarding a resident's services
INVESTIGATION FINDINGS:
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On 02/04/2022, Licensing Program Analyst (LPA) Walton arrived unannounced at the above facility to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Eddie Rangel.

During the course of the investigation, LPA conducted interviews and reviewed records. Interviews with staff revealed that the facility mails a copy of the monthly statement to the resident and/or responsible party at the end of each month.

Based on interviews and record review, the allegation: Facility does not communicate with responsible party regarding a resident's services is UNSUBSTANTIATED.

CONTINUED TO LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
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 2
Control Number 24-AS-20220118084744
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: PACIFICA SENIOR LIVING FRESNO
FACILITY NUMBER: 107202497
VISIT DATE: 02/04/2022
NARRATIVE
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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.

No deficiencies issued during this inspection.

An exit interview was conducted with Administrator. As a COVID-19 precautionary measure, a copy of this report will be provided via email. Report signed on-site by Facility Representative.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2