157204131-8-17-2020-24-AS-MHON-BSLL2W-20200818082302

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157204131
Report Date: 08/17/2020
Date Signed: 08/17/2020 02:07:42 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
01/02/2020 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 24-AS-20200102171811

FACILITY NAME:	PACIFICA SENIOR LIVING BAKERSFIELD MEMORY CARE		FACILITY NUMBER:	157204131
ADMINISTRATOR:	BRADFORD, CASSONDRA		FACILITY TYPE:	740
ADDRESS:	3115 BROOKSIDE DR		TELEPHONE:	(661) 663-9671
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93311
CAPACITY:	40	CENSUS: 38	DATE:	08/17/2020
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Cassondra Bradford, Executive Director		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Lack of supervision resulted in resident suffering multiple falls and injury.
Facility staff failed to safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

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On 08/17/2020, Licensing Program Analyst (LPA), L. Salazar, contacted Executive Director, Cassondra Bradford to deliver findings on the above allegations. Due to COVID-19 and precautionary measures, this visit was conducted via tele inspection.

During the course of the investigation, LPA conducted record reviews, interview, Licensee and Staff. LPA conducted a physical tour of the facility when complaint was opened.

Record Reviews show that the facility has been reporting the falls to CCL and R1 has been seen by Dr. R1's health is declining and will need to be on purified food and use a wheelchair for ambulatory assistance. LPA reviewed R1's inventory list on file. LPA did not observe any of the named missing items on the inventory list. Based on the information received, the allegations are UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Andy Xiong	TELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2020

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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