157204131-5-3-2024-24-AS-SMOA-D59LMB-20240514085228

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157204131
Report Date: 05/03/2024
Date Signed: 05/03/2024 12:47:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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
04/23/2024 and conducted by Evaluator Mai Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240423162001

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: 20	DATE:	05/03/2024
		UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Administrator Angela Ohanian and Memory Care Director Kelly Porter		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff lock residents in their rooms.
Staff are not following proper food safety procedures.
Facility kitchen is in disrepair.

INVESTIGATION FINDINGS:

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On 05/03/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver findings on the
above allegations. LPA introduced self, stated the purpose of the visit, and met with Administrator Angela Ohanian and Memory Care Director Kelly Porter.

During the course of the investigation, LPA conducted interviews, reviewed records, and tour the facility. Residents’ bedroom doors have lock doorknob. Residents are able to exit bedroom when doorknob is lock. Food was observed transferred in portable food warmer and properly stored. Facility kitchen stove is observed disrepair. Records were reviewed and verified that repaired has been in progress.

Based on the observation, records reviewed, and interviews conducted, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was provided to the Administrator, whose signature confirms received of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024

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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