197607592-5-21-2024-31-AS-NGID-D5RUGE-20240530153410

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607592
Report Date: 05/21/2024
Date Signed: 05/21/2024 03:03:14 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/29/2023 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20230629112859

FACILITY NAME:	PACIFICA SENIOR LIVING SANTA CLARITA		FACILITY NUMBER:	197607592
ADMINISTRATOR:	JADE ALMA		FACILITY TYPE:	740
ADDRESS:	24305 W LYONS AVE		TELEPHONE:	(661) 255-3100
CITY:	NEWHALL	STATE: CA	ZIP CODE:	91321
CAPACITY:	99	CENSUS: 63	DATE:	05/21/2024
		UNANNOUNCED	TIME BEGAN:	09:41 AM
MET WITH:	Jade Alma-Harris- Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not ensure that facility activity calendars are updated and current.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted a subsequent complaint visit to conclude the above allegation. LPA met with Jade Alma-Harris.

Entrance interview conducted.

On 07-05-2023 LPA Melissa Spaeth initiated the complaint. LPA Spaeth toured the facility, collected a resident roster, and requested the memory care activity calendar. During today’s visit LPA Ngo-Castaneda toured the facility including the memory care unit, made observations, interviewed staff/residents, and obtained copy of the facility’s activities schedule for the last 3 months.

LPA revied LIC500 (Personnel Report) which shows there are 2 full time Activity Directors, one in Assisted Living and the other in the Memory Care Unit.
Continue to LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024

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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Control Number 31-AS-20230629112859

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: PACIFICA SENIOR LIVING SANTA CLARITA	FACILITY NUMBER: 197607592
	VISIT DATE: 05/21/2024

NARRATIVE

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Allegation: Staff did not ensure that facility activity calendars are updated and current.

It was alleged that the staff did not ensure that facility activity calendars were updated and current. Today LPA Ngo-Castaneda observed and requested copies of the monthly social activities calendar which consist of arts and crafts, exercise, dances, games, bingo, cards, karaoke on Sundays, music therapy, movie time, daily chronicles, etc. The activity schedules were observed to be up to date and current.

At 10 am, LPA conducted a physical plant tour in which the LPA observed residents participating in morning exercise and morning club activity as indicated on the activity schedule in the activity room. In the memory care unit, LPA observed residents participating in a daily chronicle and card games in the activity room as indicated on the activity schedule for the day. LPA also observed the monthly social activity calendar and daily calendar posted in the elevator and hallway of the facility.

Interviews with 13 residents were conducted at 11:00 am. Thirteen out of 13 residents reveal that the facility follow activities as advertised. The Activity Director interview revealed that activities and recurrence of activities are being followed as advertised. Staff interviews revealed that activities are provided as scheduled, residents are encouraged to participate (participation is voluntary), however there may be times residents do not feel well and refuse to participate in activities.

Based on observation, interviews, and document review there is insufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted. A copy of the report was provided to the Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024

LIC9099 (FAS) - (06/04)

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