374604134-2-26-2025-08-AS-SJAB-DEBVTZ-20250228154358

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604134
Report Date: 02/26/2025
Date Signed: 02/26/2025 01:01:59 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
02/15/2022 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20220215090659

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:	172	CENSUS: 76	DATE:	02/26/2025
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Angeles Frasier, Resident Service Coordinator		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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- Unlawful Eviction(s)

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA identified herself and was granted entry by concierge Terri Park. LPA stated the purpose of the visit and reviewed the findings of the complaint with Angeles Frasier, Resident Service Coordinator.

The Department’s investigation consisted of interviews with staff and outside sources, and records review of relevant documents pertinent to this investigation. On February 15, 2022, it was alleged the facility unlawfully evicted resident(s).

It was alleged resident #1 (R1) was unlawfully being evicted from the facility due to an underlying medical condition the facility was aware of and rendering services for. During the initial visit on February 17, 2022, LPA spoke with the Executive Director, Michael McCoy, who informed LPA the facility had sent the residents’ families a notice that was not meant to be served as an eviction.
(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: 02/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

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 08-AS-20220215090659

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: 02/26/2025

NARRATIVE

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(Continuation of LIC9099)
They were aware any evictions would need to be individualized. Staff #1 (S1) said that they are aware that only the notice was sent out. The facility did not evict any residents when the notice was sent out. They worked with the families to find alternatives for their medications. The facility was removing its nursing staff and injections would not be a part of the Medication Technicians job description as they were not medical professionals. Most residents transitioned into oral medications or had outside agencies oversee their insulin medications. S1 mentioned few residents opted to move to other facilities. An interview with the Long-Term Care Ombudsman (LTCO) reviewed former notes which showed LTCO made a site visit on February 7, 2022, with no remarkable notes. LTCO received information regarding a notification sent to families for persons who need assistance with insulin care, but no additional information was entered. A letter from Pacifica Senior Living, dated February 9, 2022, said “Effective 4/09/2022 Pacifica Vista will be discontinuing our Diabetic Management program due to the Nationwide Nursing shortage.” The letter had information to contact Michael McCoy or their Regional Director of Operations with questions or concerns. According to R1s Admission Agreement, dated February 13, 2019, the facility assisted with medication management. According to R1s medication administration record, dated February 2022, it demonstrated that the primary care physician’s order indicated the units to be increased or decreased to be used depending on R1s sugar levels at bedtime. R1 was provided with their routine insulin pen to be used before meals. Physician’s Report (LIC602) dated March 10, 2021, R1 was diagnosed with cognitive impairment and was deemed unable to manage their own medications. According to the R1s assessment, dated July 15, 2020, and September 15, 2021, they were categorized as level 5 and required total medication assistance. R1 Needs and Service Plan, dated September 15, 2021, and July 15, 2020, showed R1 had a diabetic diet and needed total assistance with medications. Additional records revealed that R1s LIC 602, dated May 12, 2023, was updated to include their medications and their orders. R1s MAR, dated August 2022, said that they were taking their blood sugar medication orally. According to the Facility’s Death Report, R1 passed at the facility on September 18, 2023, where R1 received hospice services.

Based on the Department’s investigation of the above-mentioned allegation 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 Angeles Frasier, Resident Service Coordinator. A copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) were provided to Resident Service Coordinator Frasier 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: 02/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

LIC9099 (FAS) - (06/04)

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