197610025-8-24-2022-31-AS-NGID-CHRVJ5-20220829162808

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610025
Report Date: 08/24/2022
Date Signed: 08/24/2022 01:05:50 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/04/2022 and conducted by Evaluator Joscelyn Martinez

COMPLAINT CONTROL NUMBER: 31-AS-20220504165936

FACILITY NAME:	PACIFICA SENIOR LIVING NORTHRIDGE		FACILITY NUMBER:	197610025
ADMINISTRATOR:	VILLASENOR, LISA		FACILITY TYPE:	740
ADDRESS:	8700 LINDLEY AVENUE		TELEPHONE:	(818) 886-5181
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	110	CENSUS: 86	DATE:	08/24/2022
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Francis Norberte		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Facility not transporting resident's to appointments.

INVESTIGATION FINDINGS:

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On 08/24/22 Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conduct a subsequent complaint visit. Upon arrival LPA met with administrator Lisa Villasenor and the purpose of the visit was explained.

Allegation: Facility not transporting resident's to appointments.

It is alleged that facility is not transporting residents to their medical appointments. To investigate this allegation LPA interviewed ten (10) residents. Seven (7) out of ten (10) residents stated they are aware the facility provides transportation or use the facility transportation to go to their medical appointments. Interview with administrator revealed that if a resident requests transportation the facility will provide or assist in obtaining transportation. Administrator stated R1 will make their own appointments but will forget to communicate with the front desk to request transportation for their medical appointment.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn Martinez	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022

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-20220504165936

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: PACIFICA SENIOR LIVING NORTHRIDGE	FACILITY NUMBER: 197610025
	VISIT DATE: 08/24/2022

NARRATIVE

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Administrator stated they have attempted to reschedule last minute appointments due to resident’s short notice to the facility about requesting transportation. On 05/09/22, LPA arrived at the facility to conduct a 10-day initial complaint visit. During this visit, LPA observed R1 waiting near administrator office. It was revealed by R1 and administrator that R1 was waiting to go to a scheduled doctor’s appointment. Administrator was going to transport and accompany R1 to the appointment. LPA also collected email exchanges between administrator and R1’s doctor office. Emails revealed that administrator attempted to reschedule R1’s appointment but was informed by a staff that administrator was not able to cancel appointments on behalf of R1. Later emails revealed that R1’s doctors office gave permission to administrator to cancel and schedule appointments on behalf of R1 to prevent any transportation issues. Based on interviews and documents obtained, this allegation is deemed Unsubstantiated.

Administrator was unable to sign report during exit interview. Administrator authorized designee to sing on behalf.

No deficiencies cited. Exit interview conducted. Report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn Martinez	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022

LIC9099 (FAS) - (06/04)

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