157204130-1-2-2024-24-AS-SMOA-CZDSEC-20240111124830

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157204130
Report Date: 01/02/2024
Date Signed: 01/02/2024 03:19:43 PM

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
11/13/2023 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20231113093117

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: 28	DATE:	01/02/2024
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Administrator Angela Ohanian via telephone and Business Office Petra Vargas		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Facility is overcharging a resident in care.
Staff terminated resident's physical therapy services without obtaining consent.

INVESTIGATION FINDINGS:

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On 01/02/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver findings on the above allegations. LPA introduced self, stated the purpose of the visit, and requested to meet with Administrator Angela Ohanian. LPA met with Business Office Petra Vargas. Administrator was called and unable to attend meeting. LPA delivered findings to Administrator via telephone. Administrator authorized Business Office to received and sign report.

During the course of the investigation, the Department conducted interviews and reviewed records. Based on records reviewed and interviews conducted, R1’s Admission Agreement was not completed and not signed. R1’s physical therapy was discontinued on 06/07/23 by the resident’s Home Health Agency. However, R1 does not reside at the facility. R1 is a resident who resided in a memory care facility, therefore, the above allegations are UNFOUNDED, meaning they were false, could not have happened, and/or are without reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted. A copy of this report was provided to the Business Office, whose signature on this form confirms 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: 01/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024

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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