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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204130
Report Date: 01/27/2022
Date Signed: 01/28/2022 08:30:40 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:PACIFICA SENIOR LIVING BAKERSFIELDFACILITY NUMBER:
157204130
ADMINISTRATOR:BRADFORD, CASSONDRAFACILITY TYPE:
740
ADDRESS:3209 BOOKSIDE DRTELEPHONE:
(661) 663-9671
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:55CENSUS: 63DATE:
01/27/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
05:03 PM
MET WITH:Assistant Executive Director, Irma LangstonTIME COMPLETED:
05:30 PM
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On 01/27/2022, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct a Plan of Correction visit. LPA was greeted by Assistant ED. LPA explained the purpose for the visit. Covid precautionary measures were taken at the time of LPA's entry.

The plan of correction is in relation to deficiency cited on 01/14/22 for violation of Title 22, Section 87468.1. The plan of correction due date for this deficiency was 01/21/22. LPA informed Assistant Executive Director that the due date for the correction is being extended to 02/04/21 to allow facility to submit a plan to licensing, that details that the visitation schedule documented in the facility admission agreement is followed to ensure the personal rights of all residents in care.

No deficiencies cited on today's visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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