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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157204130
Report Date: 01/14/2022
Date Signed: 01/19/2022 08:16:36 AM



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
01/07/2022 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20220107150427
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: 39DATE:
01/14/2022
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Cassondra Bradford, Executive Director (ED)TIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility is restricting visitation
INVESTIGATION FINDINGS:
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On 01/14/2022, Licensing Program Anlayst (LPA) L. Salazar arrived at the facility unannounced to conduct the requird 10-day site visit. LPA was greeted by Executive Director, Cassondra Bradford, and explained the purpose for the visit. Covid precautionary measures were taken at the time of LPA's entry.

LPA conducted interviews and requested information regarding the facilities COVID visitation procedures. Based on interviews with Reporting Party and Executive Director, the preponderance of evidence standard has been met; therefore, the above allegation are found to be substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D.

An exit interview was conducted with Cassondra Bradford. A copy of this report and appeal rights were discussed and provided. A plan of correction was developed by ED and reviewed with LPA.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 24-AS-20220107150427
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: PACIFICA SENIOR LIVING BAKERSFIELD
FACILITY NUMBER: 157204130
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
01/21/2022
Section Cited
CCR
87468.1
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87468.1 Personal Rights of Residents in All Facilities
(11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement was not met as evidenced by interviews conducted with reporting party and executive director, stating visitation hours are being restricted to hours not available to family members.
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Executive Director will review CCLD current PINS and CDPH current guidelines to clarify the different guidelines given. LPA is providing PIN 21-40-ASC and regulation cited for review. ED will accommodate the families specific to resident's needs regarding visitation and personal rights.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2