197609103-9-6-2024-31-AS-EMIR-DFKMEV-20250409093316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609103
Report Date: 09/06/2024
Date Signed: 09/06/2024 02:42:23 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
06/04/2024 and conducted by Evaluator Raymond Comer

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20240604154507

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: 74	DATE:	09/06/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Vanessa Jewell		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not safeguard resident's personal belongings-

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannounced initial complaint visit on 6/04/2024, and subsequent site visit on 7/02/24. Today, 9/05/24, LPA conducted a second subsequent site visit regarding the allegation listed above.

At 9:50 AM, LPA met with facility Administrator, Vanessa Jewell, and the purpose of the visit was disclosed.

Allegation: Staff did not safeguard residnt's personal belongings-

It is alleged that jewelry items belonging to Resident#1 (R1) were stolen while living at the facility due to Staff not providing required safegards as neccessary, according to Title 22 reporting requirments. (87218)

[9099 C-Continued]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 31-AS-20240604154507

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 HOLLYWOOD HILLS	FACILITY NUMBER: 197609103
	VISIT DATE: 09/06/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA observed the posting of the facility's theft and loss policy and procedures, which are prominently displayed for viewing by residents and the public. LPA review of Staff files confirms, that during employee orientation training, facility employees are made aware of the facility theft and loss policy and their role in safeguarding resident belongings within the first 90 days of their employment.

LPA review of Resident files confirms that facility staff notify all current and new residents, upon admission, of the facility's theft and loss policy. Seven (7) out of seven (7) resident files reviewed contain a completed Client/Resident Personal Property and Valuablesinventory log with signatories acknowledging they have received, and are acquainted with, facility personal property safeguard procedures. LPA's review of Resident #1's (R1) file confirms personal items were logged as described by the Reporting Party. (RP)

Statements made by facility Administrator and facility business officer confirm, upon resident/conservator request, facility provides centralized storage of resident cash or valuables. LPA interviewed Residents#2 thru-#8 about the allegation; seven (7) out of seven (7) residents denied the allegation that Staff do not safeguard resident belongings. Residents interviewed state, while living at the facility, they have not had any personal items stolen and feel confident that Staff adequately safeguard their personal items.

Based on the evidence gathered, interviews conducted, and records reviewed by the LPA, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are unsubstantiated.

An exit interview was conducted, and a copy of the Report was provided to the Administrator.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2