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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604134
Report Date: 06/07/2023
Date Signed: 06/07/2023 12:52:20 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
06/01/2023 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230601100417
FACILITY NAME:PACIFICA SENIOR LIVING VISTAFACILITY NUMBER:
374604134
ADMINISTRATOR:ENCISO, KARENFACILITY TYPE:
740
ADDRESS:760 EAST BOBIER DRIVETELEPHONE:
(760) 941-1480
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:252CENSUS: 90DATE:
06/07/2023
UNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Executive Director, Michael McCoyTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
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5
6
7
8
9
Resident was served an unlawful eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Prgram Analyst (LPA) Janira Arreola conducted an unannounced visit to the facility in order to initate an investigation into the above allegations. LPA met with Executive Director, Michael McCoy, who was informed of the purpose of the visit. LPA conducted interviews and collected facility documents.

It was alleged that Resident #1 (R1) had received an eviction notice on 4/28/2023. It was also alleged in the complaint that the notice had been issued due to R1 having a back log of payments amounting to $20,000. LPA requested records for this from the administratration and found that the letter was titled "Final Payment Demand Letter of Balance Due". A file review was conducted prior to the visit in the regional office. LPA found that no eviction notice had been sent or approved by the department for R1. LPA showed this letter to R1 who verified that this was the letter that they had received. Therefore, the allgeation that R1 had received an eviction letter is unfounded. A finding of unfounded means that that the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted where this report along was reviewed and provided to Executive Director, Michael McCoy.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
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
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
06/01/2023 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230601100417

FACILITY NAME:PACIFICA SENIOR LIVING VISTAFACILITY NUMBER:
374604134
ADMINISTRATOR:ENCISO, KARENFACILITY TYPE:
740
ADDRESS:760 EAST BOBIER DRIVETELEPHONE:
(760) 941-1480
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:252CENSUS: 90DATE:
06/07/2023
UNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Executive Director, Michael McCoyTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not providing adequate food service to residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Prgram Analyst (LPA) Janira Arreola conducted an unannounced visit to the facility in order to initate an investigation into the above allegations. LPA met with executive director Mike McCoy, who was informed of the purpose of the visit. LPA conducted interviews and collected facility documents.

It was alleged that the food service at the facility had residents waiting one (1) to one (1) and a half hours for food service. The facility currently has a census of 90 residents with (3) seperate dining areas. Half of the facility dining area was observed to be blocked off as tiling is being done. LPA interviewed staff who stated they had not received any complaints from residents on wait times for food. LPA interviewed (5) residents, (4) in the dining area and (1) who received food in their room. The wait times reported by residents did not corroborate the allegations made, with residents reporting (15) minutes and quick service, with (30) minutes being reported as the longest they have waited. LPA spoke with executive director who stated that dining is served all day al-a-carte with specials served at certain hours. Therefore, no coroborating evidence was found to support the allegations made.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20230601100417
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PACIFICA SENIOR LIVING VISTA
FACILITY NUMBER: 374604134
VISIT DATE: 06/07/2023
NARRATIVE
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The allegation was found to be unsubstantiated, meaning the proponderance of the evidence standard has not been met.

An exit interview was conducted where this report was reviewed and provided to, Executive Director, Michael McCoy.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3