197609103-1-19-2024-31-AS-NMAN-CZRQ5H-20240123105158

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609103
Report Date: 01/19/2024
Date Signed: 01/19/2024 02:30:42 PM

Substantiated

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
01/17/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20240117120207

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: 69	DATE:	01/19/2024
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Vanessa Jewell		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Facility cental heating system is not working

INVESTIGATION FINDINGS:

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At 12:15 p.m. on 01/19/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the Executive Director (ED) and disclosed the reason for the visit.

To investigate the allegation above, LPA interviewed the ED at 12:15 p.m. today, Staff #1 (S1) at 2:00 p.m., and seven (07) out of sixty-nine (69) residents, which was at least 10% of residents, between 1:00 p.m. and 2:00 p.m., reviewed records including but not limited to the resident list, staff list, and work orders at 12:30 p.m., and toured the facility at 12:45 p.m.

Regarding the allegation “Facility central heating system is not working” it was alleged the central heating is not working. Interview with the ED revealed the facility is an old building with some structural issues.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024

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-20240117120207

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: PACIFICA SENIOR LIVING HOLLYWOOD HILLS	FACILITY NUMBER: 197609103
	VISIT DATE: 01/19/2024

NARRATIVE

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The city supplies low voltage to the building and major construction is not allowed due to the historical nature of the building. The facility has had issues with the heating system on the sixth and fourth floors of the assisted living portion since 2022. There are no heating issues in the memory care portion. The ED and the staff have taken steps to mitigate the issues on the sixth and fourth floors such as frequently calling a repair company to fix ongoing issues, placing portable heaters in resident rooms to maintain a comfortable temperature, training staff to resolve electrical issues, and supporting residents when they encounter issues. Record review revealed service reports from an outside vendor to resolve issues on 04/22/2022, 04/29/2022, 05/03/2022, 08/03/2023, 08/09/2023, 08/22/2023, 08/28/2023, and 01/04/2024. Another document showed the facility purchased seven (07) additional tower heaters for surplus on 01/11/2024. LPA toured the fourth and sixth floors with S1 and saw at least one (01) portable heater in each resident room. Interviews with residents revealed six (06) out of seven (07) residents had no issues with heating or temperature. One (01) out of seven (07) residents stated they had an issue but the facility has responded to fix it. Based on interviews, record review, and physical plant tour, the facility central heating is not working on two (02) out of seven (07) floors. The facility is maintained at a comfortable temperature, and the facility has worked to resolve all heating issues in a timely manner. Therefore, the allegation is deemed SUBSTANTIATED without deficiency at this time.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024

LIC9099 (FAS) - (06/04)

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