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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157204130
Report Date: 10/19/2020
Date Signed: 10/19/2020 03:00:30 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
11/14/2019 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20191114090536
FACILITY NAME:PACIFICA SENIOR LIVING BAKERSFIELDFACILITY NUMBER:
157204130
ADMINISTRATOR:BRADFORD, CASSONDRAFACILITY TYPE:
740
ADDRESS:3209 BOOKSIDE DRTELEPHONE:
(661) 663-9671
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:55CENSUS: 37DATE:
10/19/2020
UNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Cassondra Bradford, Executive Director (ED)TIME COMPLETED:
02:30 PM
ALLEGATION(S):
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9
Staff failed to keep the facility free of pest.
Staff is mismanaging residents personal property.
Staff refused to allow resident visitation.
INVESTIGATION FINDINGS:
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On 10/19/2020, Licensing Program Analyst (LPA), L. Salazar, contacted Executive Director (ED) to deliver findings on the above allegations. Due to COVID-19 and precautionary measures, this visit was conducted via tele inspection.

The Department has investigated the above allegations. During the course of the investigation, LPA conducted physical plant inspection, record reviews, interviews with Reporting Party (RP), Executive Director (ED), staff and family members of Resident R1 and Resident R2. LPA conducted a physical tour of the facility when complaint was opened. LPA did not observe any cockroaches at the time of inspection. Licensee provided LPA with monthly record of recent pest control receipts.

(continued on 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020
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
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
11/14/2019 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20191114090536

FACILITY NAME:PACIFICA SENIOR LIVING BAKERSFIELDFACILITY NUMBER:
157204130
ADMINISTRATOR:BRADFORD, CASSONDRAFACILITY TYPE:
740
ADDRESS:3209 BOOKSIDE DRTELEPHONE:
(661) 663-9671
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:55CENSUS: 37DATE:
10/19/2020
UNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Cassondra Bradford, Executive Director TIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to keep the facility clean.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/19/2020, Licensing Program Analyst (LPA), L. Salazar, contacted Executive Director (ED) to deliver findings on the above allegations. Due to COVID-19 and precautionary measures, this visit was conducted via tele inspection.

During the course of the investigation, LPA conducted a physical tour of the facility when complaint was opened. Record Reviews, Interviews and physical plant inspection revealed no problems with housekeeping or faciity cleanliness. Based on the information received, the allegations are UNFOUNDED.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 24-AS-20191114090536
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 BAKERSFIELD
FACILITY NUMBER: 157204130
VISIT DATE: 10/19/2020
NARRATIVE
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(continued from 9099)

Interviews did not reveal that staff refused to allow family to visit. Interview with daughter of R2 revealed the family left the facility due to R2 having cognitive difficulty at the time.

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 allegations are UNSUBSTANTIATED.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3