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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800055
Report Date: 04/05/2025
Date Signed: 04/05/2025 01:34:18 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/05/2024 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20241105103403
FACILITY NAME:PACIFICA SENIOR LIVING HEMETFACILITY NUMBER:
331800055
ADMINISTRATOR:MARK PACIAFACILITY TYPE:
740
ADDRESS:1177 S PALM AVETELEPHONE:
(951) 923-2844
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY:110CENSUS: 84DATE:
04/05/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Brittany Walsh, Sales DirectorTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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5Staff are not mitigating the spread of scabies in the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a follow up visit to deliver findings for the allegation above. LPA met with Brittany Walsh, the Sales Director, and explained the reason for the visit.

The investigation consisted of the following:
On 11/13/24, LPA Stephanie Martinez conducted the initial visit. LPA interviewed a staff, requested copies of relevant documentation, and toured two of six buildings. It was determined the allegation needed a further investigation. On 4/4/25, LPA Chan conducted interviews with the administrator, 5 staff and 9 residents.

The investigation revealed the following:
Allegation – Staff are not mitigating the spread of scabies in the facility. The administrator and staff interviewed stated there was an outbreak of scabies in November 2024. They stated they took action right away to prevent the spread to other residents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2025
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 18-AS-20241105103403
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PACIFICA SENIOR LIVING HEMET
FACILITY NUMBER: 331800055
VISIT DATE: 04/05/2025
NARRATIVE
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Staff wore gowns and gloves in the memory care unit where the outbreak occurred. They enhanced their washing and drying and separated all the residents’ clothes and beddings from others. Staff stated all the residents were given the treatment to mitigate the spread and tried to keep residents away from physical contacts as much as possible. They showered the residents more frequent during that time. Other cottages were instructed to clean and sanitize frequently and to observe for any signs of scabies. Families, visitors, and the public health department were also notified of the outbreak in the community. LPA reviewed the facility’s Infection Control Plan, and it appeared that the facility followed the procedures for any communicable disease.
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.

An exit interview was conducted with Staff B. Walsh. A copy of this report along with the appeal rights was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2