366425024-2-15-2022-18-AS-KCLS-CC74G6-20220303180457

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425024
Report Date: 02/15/2022
Date Signed: 02/15/2022 01:14:39 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
02/11/2022 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220211111625

FACILITY NAME:	PACIFICA SENIOR LIVING CHINO HILLS		FACILITY NUMBER:	366425024
ADMINISTRATOR:	JULIE OLMEDO		FACILITY TYPE:	740
ADDRESS:	6500 BUTTERFIELD RANCH RD		TELEPHONE:	(909) 606-2553
CITY:	CHINO HILLS	STATE: CA	ZIP CODE:	91709
CAPACITY:	94	CENSUS: 74	DATE:	02/15/2022
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Julie Olmedo		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Facility failed to issue a refund

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding an allegation that the facility failed to issue a refund. LPA met with Director Julie Olmedo to discuss the elements of the complaint. Olmedo states she is aware of the refund and the refund is in process as the refund is being processed through the chain of the Corporation. LPA Prieto obtained the Pacifica Senior Living Refundable Community Fee Agreement form. The form does indicate at a refund, can and is refundable, but does not specifically indicate the time frame of a refund. Director Olmedo assured a refund will be processed today, and once a check is drafted, a next day delivery to the responsible party will be made.

Based on the information obtained there is not enough evidence that the facility failed to issue a refund. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: 9512480349(323) 981-3968
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022

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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