197607592-9-24-2024-31-AS-TAGD-D9TNU4-20241007104544

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607592
Report Date: 09/24/2024
Date Signed: 09/24/2024 11:35:44 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
09/17/2024 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20240917090937

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: 56	DATE:	09/24/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Karen Enciso		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff did not ensure facility elevator is operable for residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an initial complaint visit and met with Regional Director of Operations Karen Enciso, and informed her the reason of the visit.

During today's visit, from 10am to 1145am, LPA conducted interviews and a physical plant inspection. The Regional Office received a complaint, pertaining to the one of the elevators not operating. It was confirmed that one of the elevators was not working for about (3) weeks; but the facility had one that was functioning. The Regional Director reported to LPA, that the elevator is currently working, and it was repaired on 09/18/2024. Therefore, because the facility had one elevator working, and during this visit, LPA observed both elevators working, the allegation is Unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

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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