157204130-3-19-2024-24-AS-SMOA-D3XMBB-20240402092736

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157204130
Report Date: 03/19/2024
Date Signed: 03/19/2024 10:20:18 AM

Unsubstantiated

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
01/03/2024 and conducted by Evaluator Mai Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240103105054

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: 54	DATE:	03/19/2024
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Angela Ohanian, Administrator		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Lack of care and supervision resulted in resident being hospitalized with unexplained traces of drug found

INVESTIGATION FINDINGS:

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On 03/19/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver complaint finding on the above allegation. LPA stated the purpose of the visit and met with Angela Ohanian, Administrator.

During the course of the investigation, the Department conducted interviews with staff and reviewed records. Based on records reviewed and interviews which were conducted, there was insufficient evidence to prove or disprove that the resident was hospitalized with unexplained traces of drug found. Therefore, the above allegation is found to be UNSUBSTANTIATED. An exit interview was conducted. A copy of this report was provided to the Administrator, whose signature on this report confirms receipt of this report.

Unsubstantiated

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: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

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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