197609103-10-1-2024-31-AS-EMIR-DB6UUD-20241119145317

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609103
Report Date: 10/01/2024
Date Signed: 10/01/2024 02:58:13 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
08/22/2023 and conducted by Evaluator Raymond Comer

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230822143552

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:	10/01/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Keith Bernanbe		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not supervise residents, resulting in residents entering other resident's rooms-
Staff did not provide adequate food service to resident-

INVESTIGATION FINDINGS:

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Today, Tuesday, 10/01/24, at 9:45am, Licensing Program Analyst (LPA) Raymond Comer, arrived to conduct a subsequent visit regarding the allegation(s) listed above. LPA conducted the initial complaint visit on 9/20/24. Today, LPA met with facility Business Office Manager, Delaila Betancourt, who put LPA in contact with Administrator, Vanessa Jewell, via cellphone. LPA spoke to the Administrator, and the purpose of the visit was disclosed. At 11:15am, Administrator Designee, Keith Bernanbe arrived to the facility, and assisted LPA with this complaint investigation.

At 10:20 am, A physical plant tour of the facility was conducted by LPA; No health and safety issues were observed.

Allegation: Staff did not supervise residents, resulting in residents entering other resident's rooms-

[LIC 9099C Continued]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) -596-4373
LICENSING EVALUATOR NAME: Raymond Comer	TELEPHONE: 818-401-8655
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024

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-20230822143552

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: 10/01/2024

NARRATIVE

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It is alleged that, due to a shortage of facility staffing, residents are wandering, without permission, into other resident bedrooms.

To investigate the allegation, LPA conducted a records review of the facility's current monthly work schedule, and work schedules for the months of March, 2023,and September, 2023; dates in which the reporting party (RP) states the alleged incident occurred. Based on LPA's review, the facility work schedules suggests the licensee provides sufficient staff coverage during all shifts to prohibit intrusion of unwanted/unauthorized persons into into resident bedrooms.

LPA interviews with residents revealed the following: Seven (7) out of seven (7) residents state that staffing is sufficient; they feel safe living at the facility, and have no concerns regarding the safeguarding of their personal items kept in resident bedrooms.

LPA interview with staff revealed the following: Four (4) out of four (4) staff state that facility ensures sufficient staffing during all work shifts to keep residents safe, and prohibit unwanted intrusion into resident bedrooms.

Based on LPA's observations, records review, and interviews with residents and staff,the allegation is UNSUBSTANTIATED at this time.

Allegation: Staff did not provide adequate food service to residents- It is alleged that as a result, resident#1 (R1) did not have breakfast, due to lack of staffing.

To investigate the allegation, LPA conducted a records review of the facility's current monthly work schedule, and the work schedule for the month of March, 2023; dates in which the RP stated the alleged incidents occurred. A review of the facility's work schedule reveals that the facility maintains a sufficient number of staff personnel on all shifts to provide food service for all residents. LPA interviewed seven residents who stated the following: Seven (7) out of seven (7) residents were complimentary of staff, reporting they are well informed of mealtimes and the menu of food items provided. Residents reported that meals were satisfactory and that staff consistently provide alternative meals in the event that a resident misses an opportunity to eat during a specified meal time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) -596-4373
LICENSING EVALUATOR NAME: Raymond Comer	TELEPHONE: 818-401-8655
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230822143552

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: 10/01/2024

NARRATIVE

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Residents reported that meals were satisfactory and that staff consistently provide alternative meals in the event that a resident misses an opportunity to eat during a specified meal time.

LPA interviews with staff revealed the following: Four (4) out of four (4) staff states consistency in ensuring all residents are provided food service, and that alternatives are provided when residents miss scheduled mealtimes.

Based on LPA's observations, records review, and interviews with residents and staff, the allegation is UNSUBSTANTIATED at this time.

An Exit interview was conducted, and report was provided to the Administrator.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) -596-4373
LICENSING EVALUATOR NAME: Raymond Comer	TELEPHONE: 818-401-8655
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024

LIC9099 (FAS) - (06/04)

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