197609103-4-26-2023-31-AS-NMAN-CRNLQD-20230509085723

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609103
Report Date: 04/26/2023
Date Signed: 04/26/2023 02:32:30 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/22/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20230222111436

FACILITY NAME:	PACIFICA SENIOR LIVING HOLLYWOOD HILLS		FACILITY NUMBER:	197609103
ADMINISTRATOR:	VANESSA JEWELL		FACILITY TYPE:	740
ADDRESS:	1745 N GRAMERCY PLACE		TELEPHONE:	(323) 467-3121
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90028
CAPACITY:	120	CENSUS: 68	DATE:	04/26/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Vanessa Jewell		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Residents are being mistreated while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to this facility to investigate the above allegations. LPA met with the Executive Director, Vanessa Jewell, and explained the reason for the visit.
---Residents are being mistreated while in care.
It was alleged that residents are being mistreated and neglected. To investigate the allegation, on 02/27/2023, LPA interviewed three (03) staff and four (04) residents between 3:45 PM to 04:45 PM and on 04/26/2023, LPA requested records and interviewed two (02) additional residents from 12:00 PM – 12:20 PM. Record review does not show that a mistreatment incident was reported involving identified residents. During interviews with staff, all staff stated that they are not aware of any reports of mistreatment and that they do not mistreat their residents. During interviews with residents, all residents stated that they are not being mistreated, that all staff are nice and treat them well. Based on record review and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.No health ans safety hazards noted during the visit. Exit interview conducted and a copy of the report was issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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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