374604134-3-13-2024-08-AS-JLOT-D3TNTP-20240329104501

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604134
Report Date: 03/13/2024
Date Signed: 03/13/2024 03:41:32 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/12/2021 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20210812164031

FACILITY NAME:	PACIFICA SENIOR LIVING VISTA		FACILITY NUMBER:	374604134
ADMINISTRATOR:	ENCISO, KAREN		FACILITY TYPE:	740
ADDRESS:	760 EAST BOBIER DRIVE		TELEPHONE:	(760) 946-6055
CITY:	VISTA	STATE: CA	ZIP CODE:	92084
CAPACITY:	252	CENSUS: 107	DATE:	03/13/2024
		UNANNOUNCED	TIME BEGAN:	02:55 PM
MET WITH:	Starsha Clark, Memory Care Director		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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- Licensee is not allowing resident access to telephone.
- Licensee is not allowing resident to receive visitors.

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 Executive Director Michael McCoy. LPA stated the purpose of the visit and reviewed the findings of the complaint with Memory Care Director Starsha Clark.

The Department’s investigation consisted of interviews with staff and outside sources, records review of relevant documents pertinent to this investigation, and LPA observations. On August 12, 2021, it was alleged that the facility did not allow resident access to a telephone, and the facility did not allow resident to receive visitors.

It was alleged that the facility did not allow the resident #1 (R1) to communicate with their visitors via telephone and did not make other attempts to contact R1 via facility telephone during this time. According to RP the resident was sleeping when they made the attempt to contact R1.
(Continuation on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024

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 08-AS-20210812164031

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: PACIFICA SENIOR LIVING VISTA	FACILITY NUMBER: 374604134
	VISIT DATE: 03/13/2024

NARRATIVE

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According to the former Executive Director, R1 was able to receive their phone calls in the reception area. Callers would need to call the facility and they transfer the call to the area where the resident resides. In review of the resident’s records R1 does get confused and forgetful. According to the facility’s basic services the facility does not provide a phone to the resident but when requested the Community would make reasonable access to a telephone for local calls. In review of R1’s Admission Agreement, families/residents are responsible for the telephone and the connection to their preferred company. During a visit on 09/08/2021, LPA observed that the resident had a cell phone charger plugged in to the wall and a note with the cell phone number and said the property belonged to the R1s friend and to return the property to R1. Although the charger was present the cell phone was nowhere in sight. According to an interview with R1 their POA had removed their cell phone device. Based on the information obtained there is insufficient evidence to support the allegation.

It was alleged that the facility is not allowing Resident #1 (R1) to receive their visitors. During an interview with the former Executive Director, they mentioned that R1’s power of attorney (POA) had requested R1 not to have visitors as they wanted R1 to adjust to their new surroundings. ED said that visitors had contacted a lawyer to sue their POA but R1 was unaware that they were doing so. Interviews with staff confirmed that they did refuse R1 to have their visitors enter into the community to visit with them. Staff confirmed that they proceeded with the refusal of visitors at the direction of R1’s POA. According to staff interviews there were a total of three visitors who were refused visits with R1. Interview with R1 confirmed that they recognized who two of three visitors were. In review of a self-reported incident report (IR) submitted to the San Diego Regional Office (SDRO), it said that one of R1s visitors was making R1 upset for issues that were beyond R1s control. This caused R1 to want to leave the facility and staff were unable to redirect R1. The visitor raised their voice to R1 and then told R1 that they should “bust through the doors.” Staff were able to contact R1s POA who reassured R1 everything was fine. At this time, the staff was able to redirect R1 and management requested to speak with R1s visitor outside. Staff were able to contact local law enforcement who recommended that staff not allow visitor to return to the community. If the visitor returned, they recommended the facility to call law enforcement again. According to the Physician’s Report, R1 is unable to leave the facility unassisted and is cognitively impaired. Records show that R1 does have an assigned power of attorney (POA) who is able to make their decisions for them. Based on the letters from R1’s primary care physicians which said that R1 met the criteria for neurocognitive disorder and lacked the capacity to make decisions, as such court orders had assigned R1 POA’s. Due to R1s cognitive state of mind, visits could be set-up during times when R1s family was at the facility. Based on the information obtained there is not sufficient evidence to support the allegation.

(Continuation on LIC9099-C)

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20210812164031

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: PACIFICA SENIOR LIVING VISTA	FACILITY NUMBER: 374604134
	VISIT DATE: 03/13/2024

NARRATIVE

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(Continuation of LIC9099-C)

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

The report was discussed, and an exit interview was conducted with Executive Director Michael McCoy and Memory Care Director Starsha Clark. A copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) were provided to Executive Director Michael McCoy at the conclusion of the visit. The signature below confirms the documents were received.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024

LIC9099 (FAS) - (06/04)

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