331881073-2-23-2022-18-AS-JESL-CETVV5-20220527164545

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881073
Report Date: 02/23/2022
Date Signed: 02/23/2022 03:40:54 PM

Unfounded

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
02/18/2022 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220218085144

FACILITY NAME:	PACIFICA SENIOR LIVING MENIFEE		FACILITY NUMBER:	331881073
ADMINISTRATOR:	LETH, RANCE		FACILITY TYPE:	740
ADDRESS:	28333 VALLEY BOULEVARD		TELEPHONE:	(951) 679-8811
CITY:	SUN CITY	STATE: CA	ZIP CODE:	92586
CAPACITY:	220	CENSUS: 168	DATE:	02/23/2022
		UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Rance Leth, Executive Director		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

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Resident is being overcharged.
Resident is not provided an itemized list of charges.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George arrived at the facility unannounced to deliver findings for the allegation(s) listed above. LPA met with Executive Director Rance Leth and explained the purpose of the visit and elements of the allegation(s). The department investigated the allegation of resident is being overcharged. The investigation consisted of observation, interviews and a review of documentation.

LPA reviewed documents such as Resident #1 (R1) admission agreement, rate increase notification and monthly ledger since being admitted to the community on 4/1/2021. R1 is responsible for their finances which includes paying their own rent. Per R1s ledger there is no indication of any discrepancy with being over or under charged. Per the ledger, the facility did issue a one time credit in September 2021 for the laundry fee as R1 did not feel that the facility was not doing R1s laundry and did not agree to be charged. LPA reviewed the facility charge room which indicates that on 5/25/21, R1 agreed to be charged $160 a month for laundry for both them and their significant other. There was not enough evidence

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

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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Control Number 18-AS-20220218085144

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 02/23/2022

NARRATIVE

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to support that resident is being overcharged therefore the allegation is UNFOUNDED.

Allegation: Resident is not provided an itemized list of charges.
LPA reviewed R1's monthly itemized statement that per the Business Office Manager is sent to residence of their child via US mail every month. The itemized statement shows charges listed match resident's ledger. R1 is charged for rent, laundry, and cable. The allegation of Resident is not provided an itemized list of charges is UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Therefore, the department had there dismissed the complaint.

An exit interview was conducted, and a copy of this report was provided to Executive Director Lance Reth.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

LIC9099 (FAS) - (06/04)

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