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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209116
Report Date: 08/09/2024
Date Signed: 08/12/2024 03:01:22 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
08/07/2024 and conducted by Evaluator Martin Vega
COMPLAINT CONTROL NUMBER: 24-AS-20240807151946
FACILITY NAME:PACIFICA SENIOR LIVING FRESNOFACILITY NUMBER:
107209116
ADMINISTRATOR:MONTELONGO, BRANDONFACILITY TYPE:
740
ADDRESS:1715 E ALLUVIAL AVENUETELEPHONE:
(559) 298-4900
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:100CENSUS: DATE:
08/09/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Brandon MontelongoTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure that resident is properly clothed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/09/2024 Licensing Program Analysts (LPA's) Sarah Hurt and Martin Vega arrived at the facility unannounced to conduct an investigation regarding the allegation listed above. LPA met with Administrator Brandon Montelango, and explained the purpose of todays visit.

Reagrding the allegation Staff did not ensure that resident is properly clothed. Resident 1 is considered to be an Independent living resident. State Licensing does not investigate complaints for the Independent living areas of this facility. Facility Administrator provided several documents, and a written statement acknowledging Resident 1 resides in Independent living area of this facility. This agency has investigated the complaint alleging resident properly clothed. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiencies cited today, Per Title 22 Regulations. Exit interview conducted with facility Administrator Brandon Montelango, and a copy of this report provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024
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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