197610025-8-6-2024-31-AS-TAGD-D92N25-20240912100406

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610025
Report Date: 08/06/2024
Date Signed: 08/06/2024 01:10:47 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
08/02/2024 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20240802121141

FACILITY NAME:	PACIFICA SENIOR LIVING NORTHRIDGE		FACILITY NUMBER:	197610025
ADMINISTRATOR:	IVY MITCHELL SHARP		FACILITY TYPE:	740
ADDRESS:	8700 LINDLEY AVENUE		TELEPHONE:	(818) 886-5181
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	110	CENSUS: 86	DATE:	08/06/2024
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Ivy Sharpe		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not ensuring residents are provided with toiletries
Staff are not providing adequate housekeeping services to residents
Staff are not ensuring that facility dining area is kept clean

INVESTIGATION FINDINGS:

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

On 08/06/24, at 8:40am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Administrator Ivy Sharpe. LPA disclosed the purpose of the visit. LPA explained the purpose of this visit was to gather information, conduct staff and resident interviews and deliver findings for this complaint.

The investigation consisted of the following: LPA Saucedo asked for the census, requested the staff and resident roster. At 9:15am, LPA toured the physical plant. During the tour, LPA interviewed residents and staff.

9099C-continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

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-20240802121141

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 NORTHRIDGE	FACILITY NUMBER: 197610025
	VISIT DATE: 08/06/2024

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

Regarding the allegation: Staff are not ensuring residents are provided with toiletries. It is being alleged that resident's rooms are not kept clean or stocked with toiletries, such as toilet paper and wipes. Seven (7) out of eight (8) residents were interviewed and they confirmed that they do receive toiletries either daily, every other day or/and weekly. Seven (7) out of eight (8) residents did confirm that their room is clean. Nine (9) out of nine (9) staff confirmed that residents are provided with toiletries. During LPA's physical tour, LPA observed toilet paper and wipes in all the rooms that were toured and the rooms were cleaned. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff are not providing adequate housekeeping services to residents. It is being alleged that the floors and bathrooms are not being cleaned in most of the rooms. Seven (7) out of eight (8) residents were interviewed and they confirmed that the staff do provide adequate housekeeping services. Five (5) out of six (6) staff confirmed that they have designated days of the week in which they clean the resident rooms. Some staff also confirmed that if additional cleaning is needed they will clean the room regardless if it's the resident's designated day. During LPA's physical tour, LPA observed the housekeeping and caregivers cleaning the rooms and providing services to the residents. The floors and bathrooms were also clean. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff are not ensuring that facility dining area is kept clean. It is being alleged that the dining room is not cleaned up after breakfast so when residents return to the dining area for lunch, the tables are sticky with syrup and food residue, and the floor still contains food items. Seven (7) out of eight (8) residents were interviewed and they confirmed that they do eat in the dining area and it is always clean. Five (5) out of six (6) staff confirmed that the dining area is kept cleaned. During LPA's physical tour, LPA observed the dining area to be clean. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citation(s) were issued for the above allegation(s), and a copy of this report was given to the Administrator.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2