361880893-9-29-2020-18-AS-RLAY-BU5VXV-20201006165006

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880893
Report Date: 09/29/2020
Date Signed: 09/29/2020 03:37:38 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
09/22/2020 and conducted by Evaluator Stephanie Torres

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200922123410

FACILITY NAME:	PACIFICA SENIOR LIVING HILLSBOROUGH		FACILITY NUMBER:	361880893
ADMINISTRATOR:	TAYLOR, MANDY		FACILITY TYPE:	740
ADDRESS:	11918 CENTRAL AVENUE		TELEPHONE:	(909) 548-2100
CITY:	CHINO	STATE: CA	ZIP CODE:	91710
CAPACITY:	156	CENSUS: 121	DATE:	09/29/2020
		UNANNOUNCED	TIME BEGAN:	03:04 PM
MET WITH:	Mandy Taylor, Executive Director		TIME COMPLETED:	03:09 PM

ALLEGATION(S):

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Resident is being financially abused while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Torres, contacted the facility via telephone to commence a complaint investigation via telephone due to COVID-19. The LPA identified herself and discussed the purpose of the call and the elements of the allegation with Executive Director (ED), Mandy Taylor.
Regarding the allegation, "Resident is being financially abused while in care," it was alleged Resident One (R1) was taken to their local financial instituation on September 08, 2020 by Staff One (S1). It was alleged S1 was attempting to assist R1 with their financial affairs. The Facility Personnel Report Summary was reviewed; S1's name was not identified on the report. According to Taylor, S1 is not employed by the facility. Staff interviews coroborated the ED's statement. R1 was interviewed and stated they did go to their local financial institution with S1 on September 08, 2020. R1 reported S1 is not employed by the facility and indicated S1 is their authorized representative. Based on this information, the allegation 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. An exit interview was conducted with ED, Taylor; this report was reviewed and a copy was provided. Report with facility representative signature was obtained.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Reyna Lacey	TELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020

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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