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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881073
Report Date: 07/28/2021
Date Signed: 07/28/2021 01:48:24 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
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: 151DATE:
07/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Ranch Leth, Executive DirectorTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Deborah Mullen conducted an unannounced visit to follow up on current Covid 19 procedures and protocols. LPA met with Ranch Leth, Executive Director. LPA was provided a tour of the facility at the time of the visit.

LPA discussed the current procedure in place for dining, communal and individual activities. Currently the facility has the following procedures in place:
  • Dining room is open from 7:30am to 5:30pm daily and is open seating. The tables are spaced apart to allow for social distancing.
  • The facility is holding activities in the activities room and the library room and is adhering to social distancing guidelines.
  • The pool is open by appointment for one person at a time
  • The gym is open, no appointment required but it is limited to one person at a time.
  • The chapel is open but with social distancing.
  • The game room is open for residents with social distancing. They can play pool but no cards at this time due to not being able to social distance while playing cards.
  • The facility is providing transportation but it is limited to one person at a time due to social distancing.
  • The theater is currently closed due to social distancing restrictions.
  • The bistro is open for residents, however the facility has not resumed the snacks and coffee at this time. The residents can go to the dining room from 7:30am to 5:30pm or they can ask a caregiver for snacks and/or coffee.
  • The residents are still required to wear mask in common areas in accordance with Department guidelines.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PACIFICA SENIOR LIVING MENIFEE
FACILITY NUMBER: 331881073
VISIT DATE: 07/28/2021
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Mr. Leth stated he would reopen the pool and theater with social distancing guidelines in place. Per Mr. Leth he was under the impression the current guidelines established by the Department were to have one person at a time utilizing the pool and that the theater needed to remain closed.

LPA discussed PIN 21-17.2-ASC, dated May 14, 2021 titled
"Statewide Waiver Related to Corona virus Disease 2019 (COVID-19) and Non-essential Services; Outings; New Admissions and Entertainment with Mr. Leth.

It appears the facility is in compliance with current guidelines established by the Department. Nothing further is needed at this time.

An exit interview was conducted and a copy of this report was reviewed with and provided to Mr. Leth.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
LIC809 (FAS) - (06/04)
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