<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204130
Report Date: 03/11/2022
Date Signed: 03/12/2022 09:35:00 AM


Document Has Been Signed on 03/12/2022 09:35 AM - It Cannot Be Edited

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: 37DATE:
03/11/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Cassondra Bradford, Executive Director
Irma Langston, Assistant Executive Director 		TIME COMPLETED:
01:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/11/22, Licensing Program Analysts (LPAs') L. Salazar and A. Walton arrived at the facility unannounced to conduct a Plan of Correction inspection. LPAs' were greeted by Executive Director ,Cassondra Bradford and Assistant Executive Director Irma Langston, stated the purpose of their visit and were allowed entry into the facility.

LPAs met with ED and Assistant ED and asked for the Plan of correction for deficiency cited on 01/27/2022. LPAs' observed an email from the Business office manager to the Corporate office dated 02/23/22 requesting a refund for family with 30 days. ED states there was some confusion, as a refund had been issued already after the death of resident in 2019. Executive Director stated the check will be cut today and sent to family overnight.

Civil penalties are being assessed in the amount of $100 per day for the period of March 1, 2022 through March 11, 2022 and will continue to accrue until corrected.

Exit interview conducted and report and civil penalty form were given at the time of visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1