374604134-1-31-2024-08-AS-JLOT-D226LE-20240131195414

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604134
Report Date: 01/31/2024
Date Signed: 01/31/2024 11:59:37 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/25/2020 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20201125155602

FACILITY NAME:	PACIFICA SENIOR LIVING VISTA		FACILITY NUMBER:	374604134
ADMINISTRATOR:	ENCISO, KAREN		FACILITY TYPE:	740
ADDRESS:	760 E BOBIER AVE		TELEPHONE:	(760) 691-1027
CITY:	VISTA	STATE: CA	ZIP CODE:	92084
CAPACITY:	252	CENSUS: 107	DATE:	01/31/2024
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Michael McCoy, Executive Director		TIME COMPLETED:	11:35 AM

ALLEGATION(S):

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- Facility staff neglected to assist residents with incontinence care
- Facility staff neglected to keep residents room clean from odors

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. LPA identified herself and was granted entry by Jonalyn Libunao, Business Office Manager. LPA stated the purpose of the visit and reviewed the findings of the complaint with Executive Director (ED) Michael McCoy,and Esmeralda Reyes, Resident Service Director (RSD).

The Department’s investigation consisted of interviews with staff and outside sources, records review of relevant documents pertinent to this investigation. On November 25, 2020, it was alleged that the facility staff neglected to assist residents with incontinence care; and facility staff neglected to keep residents’ room free from odors.

It was specifically alleged that resident #1 (R1) was not changed throughout the night and had dried fecal matter stuck to their skin. Interviews with former and current staff said that they did not have any issues with changing residents. They were short staffed, but they managed to check their assigned residents when needed, which would be about every 2 hours.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 08-AS-20201125155602

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: PACIFICA SENIOR LIVING VISTA	FACILITY NUMBER: 374604134
	VISIT DATE: 01/31/2024

NARRATIVE

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If they were wet, they would be changed. According to a former staff member, they would be assigned approximately 20 to 30 residents, but they checked if changing was needed. They mentioned that there may have been times where other staff may not have changed all their residents, but they never witnessed, nor did they miss in changing their assigned residents. Staff and former staff did say that there were residents who would either refuse or give staff difficulties changing them. When this occurred, staff would switch resident checks to observe if another staff member would be able to assist with those who refused or had difficulties with. No staff reported issues with other shifts not keeping up with their checks. Former and current staff reported working well with their co-workers. In review of the facility documents, it was noted that the resident had a loss of cognitive functioning and needed one-person standby assistance for toileting needs. Documents show that the facility needed to assist the resident in the bathroom every two hours for toileting assistance. According to the facility service plan, it annotated that incontinence care or toileting service while resident is awake; if the resident refused, they would need to inform nurse on duty and or the RSD; also, if resident refused care to a care staff, they would try change of staff face technique. It was noted that the resident was able to shower self and noted that at times R1 refused to be showered by their third-party agency. The facility did have incontinence checks logs for R1 the months of August 2020 and September 2020 only. According to records, staff would change the R1 between 6:30 AM – 7:30 AM; with mainly staying within the range assisting the resident in the morning with incontinence care at about 7:00 AM. The facility staff incontinence checks ranged daily between 28 minutes to about 3 hours but staying within the range of checking R1 every 2 hours between the hours of around 7 AM until about 10 PM. Incontinence checks indicated if the resident needed to be changed or was dried at the time of the check. Based on the information obtained during interviews and records reviewed, there is insufficient evidence to support the allegation.

It was specifically alleged that due to staff not changing R1 throughout the night, R1’s entire room was malodorous when they opened their door. Staff and former staff interviewed did not raise concerns regarding residents not being changed during their assigned shifts. If staff did not have issues with residents being changed, there would be no indication that there were residents who had a malodorous room due to staff not checking residents’ incontinence care. Based on the evidence obtained during the investigation, there is insufficient evidence to support the allegation.

Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained during staff and outside sources interviews and records reviewed, there is insufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegations are deemed to be unsubstantiated.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20201125155602

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: PACIFICA SENIOR LIVING VISTA	FACILITY NUMBER: 374604134
	VISIT DATE: 01/31/2024

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	The report was discussed, and an exit interview was conducted with Executive Director McCoy, and Resident Service Director Reyes. A copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) were provided to ED McCoy at the conclusion of the visit. The signature below confirms the documents were received.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

LIC9099 (FAS) - (06/04)

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