197609103-2-14-2025-31-AS-EMIR-DEYV48-20250321160550

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609103
Report Date: 02/14/2025
Date Signed: 02/14/2025 02:12:26 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
02/10/2025 and conducted by Evaluator Raymond Comer

COMPLAINT CONTROL NUMBER: 31-AS-20250210120851

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:	02/14/2025
		UNANNOUNCED	TIME BEGAN:	06:05 AM
MET WITH:	Vanessa Jewell		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Night Shift Staff not meeting incontinance needs of residents in care-

INVESTIGATION FINDINGS:

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On Friday, 2/14/25, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannounced, initial10-day complaint visit to investigate the above allegation(s). LPA met with Memory Care Director, Esmeralda Guevara,and presented official CDSS identification. At 9:00am, the Administrator arrived to the facility and LPA disclosed reason for the visit.

To investigate this allegation, LPA received Facility resident roster, and staff roster. Between 6:15 am, and 8:30 am, LPA conducted random observations of resident bedrooms, and interviewed seven (7) residents. Between 8:45 am, and 12:35 pm, LPA interviewed the Administrator, and seven (7) staff.

Allegation: Night Shift staff not meeting incontinence needs of residents in care- Reporting Party (RP) alleges that night shift staff neglected to provide incontinence service assistance to memory care residents.

[LIC 9099C]- Continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025

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-20250210120851

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: 02/14/2025

NARRATIVE

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To investigate the allegation, LPA conducted observations of random bedrooms in the memory care unit: (Memory Care Bedrooms #2009, #2011A/B, #2010, #2004A, #2003, #3003, #3004, #3007, #3016)
LPA observations revealed the following: All observed bedrooms appeared as clean and organized; no foul odors detected. Residents in observed bedrooms appeared to be clean and dry, blankets and bedsheets appears as clean, and residents observed wearing clean diapers, and showing no trace of urine or feces.
LPA conducted interviews with the Memory Care Director which revealed the following: Current Memory Care Unit (MCU) census is twenty nine (29). During morning (6:00 am-2:30 pm) and afternoon (2:30 pm-10:00pm) shifts, the MCU comprises four (4) caregiver staff, and one (1) Med Tech. During the night shift, (10:00 pm-6:00 am), the facility comprises three (3) caregiver staff, and one (1) Med Tech. The Memory Care Director states that all incontinent residents are changed a minimum of three (3) times per shift, and as needed. Six (6) staff members interviewed by LPA corroborated statement provided by the MCD.
LPA conducted interviews with three (3) residents from the memory care unit, and four (4) residents from the assisted living unit. All, a total of seven (7) out of seven (7) residents, interviewed stated that staff provide satisfactory incontinence assistance and expressed no concerns regarding this allegation.

Therefore, based on LPA interviews with staff, residents and observations, this allegation is deemed Unsubstantiated, at this time.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025

LIC9099 (FAS) - (06/04)

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