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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 247206921
Report Date: 08/18/2025
Date Signed: 08/18/2025 02:52:25 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/14/2025 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250514162917
FACILITY NAME:PACIFICA SENIOR LIVING MERCEDFACILITY NUMBER:
247206921
ADMINISTRATOR:EMILY VENEGASFACILITY TYPE:
740
ADDRESS:3420 R STTELEPHONE:
(209) 580-6124
CITY:MERCEDSTATE: CAZIP CODE:
95348
CAPACITY:93CENSUS: 84DATE:
08/18/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Administrator Lisa Baricevic TIME COMPLETED:
01:05 PM
ALLEGATION(S):
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Unqualified staff providing care to residents
Staff are inappropriately increasing resident's rent due for a change in level of care
Staff are not responding to resident's call button in a timely manner
Staff are accepting residents not in plan of operation
INVESTIGATION FINDINGS:
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On 08/15/2025, Licensing Program Analyst (LPA) V. Gorban arrived unannounced to deliver findings on a complaint investigation. LPA explained the purpose of the visit to receptionist Tanya Linan and was allowed entry. Administrator Lisa Baricevic was notified and attended the licensing visit.

During the course of the investigation, LPA conducted a facility tour, conducted interviews, and reviewed records.
The Department has investigated the allegation: Unqualified staff providing care to residents. Based on interviews conducted and records reviewed, personnel records meet the requirements necessary to provide services to residents in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Report continues on attached LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
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 24-AS-20250514162917
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: PACIFICA SENIOR LIVING MERCED
FACILITY NUMBER: 247206921
VISIT DATE: 08/18/2025
NARRATIVE
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The Department has investigated the allegation: Staff are accepting residents not in plan of operation. Based on interviews conducted and review records, there are two different types of residents accepted by the facility: assisted living and memory care. The facility’s plan of operation addressed the care and restricted health care for the residents. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

The Department has investigated the allegation: Staff are not responding to resident's call button in a timely manner. Based on records reviews and staff interviews, records revealed that residents (R1, R2 and R3) calls waiting due to not resetting the system after providing care to residents in timely manner. Per residents interviews no concerns regarding call response was stated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

The Department has investigated the allegation Staff are inappropriately increasing resident's rent due for a change in level of care. Based on records reviews and interviews conducted, the facility charged resident (R1) in the amount of $950 instead of $900 per admission agreement contract. The resident was credited back the overcharge amount by the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted. Report signed on-site. A copy of this report was discussed and provided to the administrator.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2