336425840-8-17-2022-56-AS-KCLS-CQLSQ7-20230405140412

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336425840
Report Date: 08/17/2022
Date Signed: 08/17/2022 04:27:02 PM

Unsubstantiated

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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/10/2022 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220810110900

FACILITY NAME:	PACIFICA SENIOR LIVING RIVERSIDE		FACILITY NUMBER:	336425840
ADMINISTRATOR:	EVA TAWFIK		FACILITY TYPE:	740
ADDRESS:	6280 CLAY STREET		TELEPHONE:	(951) 360-1616
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92509
CAPACITY:	110	CENSUS:	DATE:	08/17/2022
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Eva Tawfik		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Neglect/lack of supervision resulting in resident sustaining stage two pressure ulcer.
Facility is not adequately staffed to meet clients needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding allegations that due to neglect/lack of supervision resulting in resident sustaining stage two pressure ulcer and the facility is not adequately staffed to meet clients needs. LPA met with Executive Director Eva Tawfik ad toured facility where resident #1 (R1), in question, resided. LPA interviewed witness, who stated R1, was, and has been, treated for pressure ulcers. R1 is under the care of several care staff, including staff at the facility. Staff #1 (S1) was interviewed and explained the care of R1 while at the facility, which is appropriate for R1's level of care. Staff is aware of R1's health condition and are meeting the care needs. Staff was interview and documentation was obtained to show that the facility is adequately staffed to meet the needs of the clients.

Based on the information obtained there is not enough evidence that due to neglect/lack of supervision resulting in resident sustaining stage two pressure ulcer and the facility is not adequately staffed to meet clients needs . Therefore, the allegations are deemed UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

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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