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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881073
Report Date: 12/29/2023
Date Signed: 12/29/2023 11:12:45 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 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
07/26/2023 and conducted by Evaluator Jacqueline Shaw Ross
COMPLAINT CONTROL NUMBER: 18-AS-20230726162249
FACILITY NAME:PACIFICA SENIOR LIVING MENIFEEFACILITY NUMBER:
331881073
ADMINISTRATOR:LETH, RANCEFACILITY TYPE:
740
ADDRESS:28333 VALLEY BOULEVARDTELEPHONE:
(951) 679-8811
CITY:SUN CITYSTATE: CAZIP CODE:
92586
CAPACITY:220CENSUS: 199DATE:
12/29/2023
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Christina Mulligan, Resident Care CoordinatorTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Facility is not maintained in good repair
Staff does not ensure that facility is maintained at a comfortable temperature
Staff does not ensure that facility dishes are properly cleaned and sanitized
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jacqueline Shaw Ross made an unannounced visit to the facility to deliver findings on a complaint investigation regarding the allegations listed above. LPA met with Christina Mulligan, Resident Care Coordinator, and explained the purpose of the visit. During the investigation interviews and record reviews were conducted.

On 7/26/2023, Community Care Licensing received an allegation that the facility is not in good repair. It was alleged that the elevator located near the dining area keeps breaking down and is always out of service. Records review demonstrated that the facility has a contract with an elevator servicing company. LPA viewed documents which show service request dates and the date of service each time the elevator was not working. Documents viewed show that the elevator was repaired within 24 hours. Interviews with staff also demonstrated that the elevator was fixed in a timely manner and the facility made reasonable accommodations for residents to mitigate the impact. Interviews with residents demonstrated the impact was minimal and that residents had the option of using two other elevators as well as using a walkway ramp that is located outside next to the elevator. Based on observation, interview and record review this allegation is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2023
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-20230726162249
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PACIFICA SENIOR LIVING MENIFEE
FACILITY NUMBER: 331881073
VISIT DATE: 12/29/2023
NARRATIVE
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On 7/26/2023, a complaint was received alleging staff does not ensure that the facility is maintained at a comfortable temperature for the residents. During the investigation interviews and record reviews were conducted. Interviews with residents revealed that it gets warm in the assisted living dining area but it is not unbearable because there are fans placed throughout the dining area. Residents interviewed also stated they are able to have their meals delivered to their rooms if it gets too warm. Interviews with staff revealed a new air conditioning system has been ordered for the assisted living dining area and in the meantime, fans are placed throughout the area. Staff also stated residents have the option of having meals delivered to their rooms. LPA toured the dining area and noticed three huge fans placed throughout the area. LPA observed the temperature to be at a comfortable level at the time. LPA viewed documents that revealed a purchase order for a new air conditioning system was placed for the dining area and expected to arrive in a few months. LPA also toured select residential units that were experiencing air conditioning issues. LPA observed portable air conditioners in place and units maintained a cool temperature. Based on observation, interview and record review this allegation is UNSUBSTANTIATED.

On 7/26/2023, a complaint was received alleging staff does not ensure that facility dishes are properly cleaned and sanitized. LPA toured the kitchen area and inspected the dishwashing system. LPA observed a demonstration of dishes being cleaned and sanitized. LPA also observed clean dishes and clean silverware stored on shelves and on dining tables. Of the interviews conducted with residents, all residents indicated they were satisfied the facilities dishes, cups, silverware and that they all appeared to be clean. Of the interviews conducted with staff, all staff stated they have not observed or heard anyone complain about unclean or unsanitized dishes. Based on observation, interview and record review this allegation is UNSUBSTANTIATED; meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2