374603451-2-13-2025-18-AS-JDHS-DE4U8K-20250221142141

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603451
Report Date: 02/13/2025
Date Signed: 02/13/2025 02:29:40 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
01/23/2024 and conducted by Evaluator Kathleen Banrasavong

COMPLAINT CONTROL NUMBER: 18-AS-20240123164701

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: 111	DATE:	02/13/2025
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Sales Director, Carline Callaghan		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Facility staff left residents in soiled clothing.
Facility staff do not keep the facility free of odors.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kathleen Banrasavong conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA met with Sales Director, Carline Callaghan, where the LPA explained the purpose of the visit and the elements of the allegations. The investigation consisted of observations, interviews with staff members and residents, and a review of records.

On January 23, 2024, Community Care Licensing received a complaint alleging that the facility staff left residents in soiled clothing and that the facility staff do not keep the facility free of odors. It was alleged that a resident was left in soiled diapers and that Resident (1) R1’s wheelchair was soaked in urine. Executive Director Shaun McGuirk indicated that R1 refused to have their diapers or bedding changed. It was also advised that R1 constantly refused showers and change of clothes. Information obtained from additional staff members corroborated the information that R1 refuses to shower or allow staff to change their bedding. It was advised that staff document R1’s refusals on a log. Staff did stated that R1’s room has an odor due to the refusal of assistance, but staff clean and sanitize the room once a week and more frequently as on a need for service basis.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-622-3619
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025

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-20240123164701

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: PACIFICA SENIOR LIVING ESCONDIDO	FACILITY NUMBER: 374603451
	VISIT DATE: 02/13/2025

NARRATIVE

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Information obtained from interview with R1 corroborated that they refuse to be showered and allow staff to change their bedding. R1 denied that there are odors coming from their room. It was further advised that R1 does not have any issues or concerns. Information from additional witness corroborated the information that they are aware of R1’s refusals to be showered and change their bedding. During a visit, LPA conducted a room tour of R1’s room and observed and no issues were observed. LPA also observed R1’s refusals on logs dated from the month of November 2023, December 2023 and January 2024 .

Based on information obtained through interviews, review of documents, and observation, this agency has investigated the complaint alleging facility staff left residents in soiled clothing and facility staff do not keep the facility free of odors. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted, and a copy of this report was discussed with and provided to Sales Director, Carline Callaghan.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-622-3619
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025

LIC9099 (FAS) - (06/04)

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