331880550-9-1-2020-18-AS-NBRN-BTBSHE-20200910135322

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880550
Report Date: 09/01/2020
Date Signed: 09/01/2020 02:15:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/14/2020 and conducted by Evaluator Amy Goldenberg

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200814160644

FACILITY NAME:	PACIFICA SENIOR LIVING PALM SPRINGS		FACILITY NUMBER:	331880550
ADMINISTRATOR:	MILLER, CRISTINA		FACILITY TYPE:	740
ADDRESS:	1780 E BARISTO RD		TELEPHONE:	(760) 322-3444
CITY:	PALM SPRINGS	STATE: CA	ZIP CODE:	92262
CAPACITY:	95	CENSUS: 87	DATE:	09/01/2020
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Robert Stansbury, Resident Services Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility has mold in walk-in refrigerator

INVESTIGATION FINDINGS:

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Amy Goldenberg, Licensing Program Analyst (LPA), is conducting this visit to conclude this agency’s investigation into the complaint allegation mentioned above. This visit was conducted telephonically due to COVID-19 as a precautionary measure.

During this investigation LPA toured the walk-in refrigerator via facetime call and conducted two (2) interviews with staff. Investigation revealed the following: LPA observation through a facetime tour of the walk-in refrigerator did not reveal evidence of mold. Two (2) of two (2) staff interviewed deny that there is a mold problem in the walk-in refrigerator.

Based on the aformentioned, we have found the complaint allegation is unfounded, meaning that the allegation was false, could not have happened and is without a reasonable basis. We have therefore dismissed the complaint. A copy of this report is being reviewed telephonically with the facility representative and a copy is being furnished via email.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 248-0351
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2020

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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