157204130-7-21-2021-24-AS-MHON-C57L3K-20210723082402

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157204130
Report Date: 07/19/2021
Date Signed: 07/21/2021 12:59:57 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
08/14/2020 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 24-AS-20200814142025

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:	DATE:	07/19/2021
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Executive Director, Cassondra Bradford		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility staff are not assisting resident with transferring needs
Facility staff are chemically restraining residents

INVESTIGATION FINDINGS:

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On 07/19/2021, Licensing Program Analyst (LPA) L. Salazar arrived unannounced at the facility to deliver findings on the above allegations. LPA introduced self and requested to speak with the Executive Director (ED). LPA met with Executive Director, (ED) LPA explained the purpose of the visit.

During the course of the investigation, LPA conducted interviews and reviewed records. Interviews revealed Resident R1 was in charge of their own care and refused treatment. Records review show medication changes for a PRN pain medication on 08/04/20. On 08/06/20, two PRN pain medications were increased. On 08/14/20, same medications were decreased.

Based on interviews conducted with staff and records review, the allegations are UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficencies cited. Exit interview conducted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

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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