157204130-8-18-2023-24-AS-SMOA-CUTV98-20230818161356

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157204130
Report Date: 08/17/2023
Date Signed: 08/18/2023 11:25:37 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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
08/15/2023 and conducted by Evaluator Mai Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20230815132142

FACILITY NAME:	PACIFICA SENIOR LIVING BAKERSFIELD		FACILITY NUMBER:	157204130
ADMINISTRATOR:	BRADFORD, CASSONDRA		FACILITY TYPE:	740
ADDRESS:	3209 BOOKSIDE DR		TELEPHONE:	(661) 663-9671
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93311
CAPACITY:	55	CENSUS: 27	DATE:	08/17/2023
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Irma Langston, Executive Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not keep facility free of pests resulting in residents sustaining multiple ant bites

INVESTIGATION FINDINGS:

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On 08/17/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct initial complaint investigation. LPA introduced self, stated the purpose of the visit, and met with Executive Director Irma Langston.

During the course of the investigation, LPA conducted tour of facility, reviewed records, and interviews were conducted. The facility have continuation monthly pest control service and weekly bedroom check for ants on regularly basis since January 2023.

Based on observation, records reviewed, and interviews which were conducted, therefore, the allegation above is founded to be UNFOUNDED. We have therefore dismissed the complaint. An exit interview was conducted, and a copy of this report was provided to Executive Director, whose signature confirm receipt of this report.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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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