247206921-5-3-2023-24-AS-MHON-CSHTEP-20230605144013

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 247206921
Report Date: 05/03/2023
Date Signed: 05/03/2023 02:33:10 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
01/06/2023 and conducted by Evaluator Malia Thao

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20230106152902

FACILITY NAME:	PACIFICA SENIOR LIVING MERCED		FACILITY NUMBER:	247206921
ADMINISTRATOR:	DANIEL GORMLEY		FACILITY TYPE:	740
ADDRESS:	3420 R ST		TELEPHONE:	(209) 580-6124
CITY:	MERCED	STATE: CA	ZIP CODE:	95348
CAPACITY:	93	CENSUS: 65	DATE:	05/03/2023
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Shelly Randel, Executive Director (Administrator)		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility staff do not respond to call bell in a timely manner.
Facility not providing adequate food service.

INVESTIGATION FINDINGS:

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On 5/3/23 at 9:35 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a complaint inspection. LPA explained reason for inspection and met with Administrator Shelly Randel.

LPA made observations, conducted interviews, and reviewed records. Based on LPA's observations, interviews, and record review, LPA found that although the signal system logs may show extended response times of 10-60 minutes, staff may sometimes forget to clear the call or the devices used do not immediately get cleared and is a technical issue, and it was observed that staff responded within an average time of 5 minutes or less; and that facility cooks hot fresh meals daily but sometimes may become cooled by the time the food is delivered to a resident's room, at which point the staff, or per resident request, would then warm up the food again by microwave. Therefore, the above allegations are unsubstantiated. The allegations may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted. Due to technical difficulties, a copy of this report was emailed to Administrator with "read receipt" to confirm receipt of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia Thao	TELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023

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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