374603451-6-22-2022-18-AS-MVAO-CV7P8P-20230830110553

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603451
Report Date: 06/22/2022
Date Signed: 06/22/2022 01:16:37 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
06/13/2022 and conducted by Evaluator Tricia Danielson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220613104637

FACILITY NAME:	PACIFICA SENIOR LIVING ESCONDIDO		FACILITY NUMBER:	374603451
ADMINISTRATOR:	AMY BANAGA		FACILITY TYPE:	740
ADDRESS:	1351 E WASHINGTON AVE		TELEPHONE:	(760) 741-3055
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92027
CAPACITY:	143	CENSUS: 104	DATE:	06/22/2022
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Amy Banaga, Executive Director		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff hit resident in care.
Staff yelling at resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to initiate an investigation into the allegations listed above. LPA met with Executive Director Amy Banaga and explained the purpose of the visit.
During today's visit, LPA toured the memory unit of the facility, interviewed seven (7) residents, six (6) staff and reviewed pertinent records. Regarding the allegations "Staff hit residents in care" and "Staff yelling at resident", it was alleged that a resident was overheard to be screaming while being assisted by staff during an adult brief changing and that a slap noise was also overheard. It was further alleged that staff have been overheard to yell at residents to be quiet and get out of the hallway. Seven (7) of seven (7) residents interviewed denied ever experiencing a staff hit them or yell at them in anyway nor did they report any complaints regarding their residency at the facility. Records reviewed indicated identified residents who experience difficulties during bathing and/or brief changing activities and these difficulties are being addressed on an ongoing basis. This agency has investigated the complaint alleging "Staff hit resident in care" and "Staff yelling at resident". We have found that the complaint was unfounded, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. An exit interview was conducted and a copy of this report was provided.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022

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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