374604134-3-13-2024-08-AS-JLOT-D3TRBE-20240329125237

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604134
Report Date: 03/13/2024
Date Signed: 03/13/2024 03:44:33 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
09/02/2021 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20210902145842

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:	03:20 PM
MET WITH:	Michael McCoy, Executive Director, and Starsha Clark, Memory Care Director		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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- Staff are not allowing resident to leave the facility.

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

The Department’s investigation consisted of interviews with staff and outside sources, and records review of relevant documents pertinent to this investigation.

On September 2, 2021, it was specifically alleged that the facility did not allow the resident to leave the facility to conduct his daily activities with them or other acquaintances.

(Continuation on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Carmen Lopez
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-20210902145842

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)

It was specifically alleged that the facility did not allow resident #1 (R1) to leave the facility. According to the residents Physician’s Report (LIC602), R1 had cognitive impairment and was unable to leave the facility unassisted. Per LIC602, R1’s mental condition was confused and disoriented. Letters from R1’s primary care physicians say that R1 met the criteria for neurocognitive disorder and lacked the capacity to make decisions such as medical and financial decisions and would benefit from having a fiduciary. According to court documents, R1 had been assigned power of attorney’s (POA) for medical and financial decisions. The facility had submitted an incident report to the Department indicating that the Sherriff’s Department was contacted as a visitor was making R1 uneasy and anxious and wanted to take R1 out of the facility. According to the report, the Sherriff’s Department recommended contacting them if that visitor attempted to return. According to the former Executive Director, the facility was ensuring safety measures for R1 were met.

Based on the Department’s investigation of the above-mentioned allegation 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 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, to whom a copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) were provided at the conclusion of the visit. The signature below confirms the documents were received.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Carmen Lopez
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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