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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157204130
Report Date: 11/06/2024
Date Signed: 11/15/2024 11:07:01 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
10/02/2024 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20241002155945
FACILITY NAME:PACIFICA SENIOR LIVING BAKERSFIELDFACILITY NUMBER:
157204130
ADMINISTRATOR:OHANIAN, ANGELAFACILITY TYPE:
740
ADDRESS:3209 BOOKSIDE DRTELEPHONE:
(661) 663-9671
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:55CENSUS: 23DATE:
11/06/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kelli Porter, Memory Care DirectorTIME COMPLETED:
10:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff caused bruising to resident
Facility staff handled resident in a rough manner
Facility staff are forcing residents out of bed against their will
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/06/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver complaint findings on the above allegations. LPA stated the purpose of the visit and met with Memory Care Director Kelli Porter.

During the course of the investigation, LPA toured the facility, reviewed records, and conducted interviews. R1 confirmed bruising was not caused by staff. Residents confirmed staff assists the residents as needed. Residents confirmed that staff do not force resident out of bed against their will. Residents sleeps in until the residents are ready to get up to get ready for the day. Based on interviews which were conducted, staff alleged caused bruising to resident, staff alleged handled resident in a resident in a rough manner and forcing resident out of bed against their will, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UBSTANTIATED. An exit interview was conducted. A copy of this report was provided to the Memory Care Director, whose signature on this report confirms receipt of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024
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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