157204131-5-3-2024-24-AS-SMOA-D59LN2-20240514085339

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157204131
Report Date: 05/03/2024
Date Signed: 05/03/2024 12:37:37 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
04/24/2024 and conducted by Evaluator Mai Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240424144836

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:	12:25 PM
MET WITH:	Kelly Porter, Memory Care Director		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Resident sustained fracture while in care.

INVESTIGATION FINDINGS:

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

During the course of the investigation, interview was conducted, and records were reviewed. An internal report dated 01/21/24 indicates that “no new fractures happened” following a visit to the ER.

Based on records reviewed and interview conducted, the preponderance of evidence standard has not been met, therefore the above allegation is found to be UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was provided to the Memory Care Director, 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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