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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604134
Report Date: 12/23/2019
Date Signed: 09/29/2020 04:47:46 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/25/2019 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20191125100700
FACILITY NAME:PACIFICA SENIOR LIVING VISTAFACILITY NUMBER:
374604134
ADMINISTRATOR:ENCISO, KARENFACILITY TYPE:
740
ADDRESS:760 E BOBIER AVETELEPHONE:
(760) 691-1027
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:252CENSUS: 142DATE:
12/23/2019
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Executive Director, Karen EncisoTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff refused to allow visitation for resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced virtual Facetime call to deliver findings on the above-mentioned allegation due to COVID-19. LPA Correia identified herself and discussed the purpose of the call and the elements of the allegation with Execute Director (ED), Karen Enciso.
The Department’s investigation consisted of staff, residents, outside source interviews, and a record review.
In regard to the above mentioned allegation, interviews with facility staff and outside sources revealed that the ED excluded the individual from conducting visits to Resident (R1). Interviews with residents and outside sources also revealed the individual was providing resident assistance by hire to R1, and approximately 12 other residents at the facility. An interview with the individual corroborated receiving payment to provide residents with assistance and companionship. A record review also revealed during the time the individual was assisting residents a criminal clearance exemption was requested by the Care Giver Background Check Bureau (CBCB)for this individual which immediately prohibits individuals from entering facility grounds.
This agency has investigated the complaint alleging the facility ED refused R1 visitation rights. We have found that the complaint allegation was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.
An exit interview was conducted, and a copy of this report was provided to Execute Director, Karen Enciso via electronic mail. A confirmation of receipt was requested.

This is an amended complaint investigation report delivered on December 23, 2019.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2019
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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/25/2019 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20191125100700

FACILITY NAME:PACIFICA SENIOR LIVING VISTAFACILITY NUMBER:
374604134
ADMINISTRATOR:ENCISO, KARENFACILITY TYPE:
740
ADDRESS:760 E BOBIER AVETELEPHONE:
(760) 691-1027
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:142CENSUS: DATE:
12/23/2019
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Executive Director, Karen EncisoTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff yelled at visitor in front of residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver investigative findings on the above listed complaint allegation. LPA was met and granted entry into the facility by Executive Director, Karen Enciso and explained the reason for the visit.
The Department’s investigation consisted of staff, residents, and outside source interviews.
In regard to the above allegation, interviews conducted with residents, responsible parties, and outside sources did not reveal evidence to support that staff yelled at visitor. The reporting party became aware of the incident through an outside party. They did not witness the incident. Due to the lack of corroborating evidence, the finding regarding the above allegation is unsubstantiated. This finding means although the allegations may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violations occurred.
An exit interview was conducted, Licensee/Appeal Rights (LIC 9098 01/16) along with a copy of this report was provided to Executive Director, Karen Enciso and their signature on this form confirms receipt of these rights.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2019
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 08-AS-20191125100700
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PACIFICA SENIOR LIVING VISTA
FACILITY NUMBER: 374604134
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
12/23/2019
Section Cited
CCR
87468.1
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Personal Rights of Residents in All Facilities(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(11)To have their visitors... permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon.

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Executive Director Karen Enciso plans to appeal the finding. Until appeal process is complete visitation will resume.
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This regulation is not met as evidenced by: Facility staff prohibited C1 from the premises of the facility property due to a criminal background clearance issue. Visitor meets with R1 and several other residents on a regular basis to provide services that do not entail care and supervision as performed by facility staff. Persons who are listed on the facility’s visitation list and are not contracted or working for the facility at any capacity, do not require criminal background clearance therefore facility personnel does not have jurisdiction to decline visitor's entrance into the facility. This poses a potential health risk to resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2019
LIC9099 (FAS) - (06/04)
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