374604134-2-26-2025-18-AS-JDHS-DEATGB-20250227134249

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604134
Report Date: 02/26/2025
Date Signed: 02/26/2025 09:52:05 AM

Unsubstantiated

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
04/25/2023 and conducted by Evaluator Venus Mixson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230425102920

FACILITY NAME:	PACIFICA SENIOR LIVING VISTA		FACILITY NUMBER:	374604134
ADMINISTRATOR:	ENCISO, KAREN		FACILITY TYPE:	740
ADDRESS:	760 EAST BOBIER DRIVE		TELEPHONE:	(760) 941-1480
CITY:	VISTA	STATE: CA	ZIP CODE:	92084
CAPACITY:	172	CENSUS: 90	DATE:	02/26/2025
		UNANNOUNCED	TIME BEGAN:	09:13 AM
MET WITH:	BUSINESS OFFICE MANAGER, JHONALYN LIBUNAO		TIME COMPLETED:	09:52 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not meet resident's dietary needs
Staff did not meet resident's toileting needs
Staff did not answer resident's call button in a timely manner

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On February 26, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility to deliver the allegation findings and met with Business Office Manager, Jhonalyn Libunao.

On April 25, 2023, Community Care Licensing received a complaint alleging that staff are not meeting resident’s dietary and toileting needs and staff do not answer resident’s call button in a timely manner. During the investigation LPA conducted interviews, record reviews, and made observations. It was reported that staff left Resident #1 (R1) sitting on the toilet for 30 minutes or more. It was also reported that it takes facility staff an extended amount of time to answer call buttons. Concerns were also reported that R1 was being charged for a puree diet but was not receiving pureed foods.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
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)

Page: 1 of 2

Control Number 18-AS-20230425102920

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: 02/26/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the allegation staff did not meet resident’s toileting needs, it was reported that on April 4, 2023, staff left R1 sitting on the toilet 30 minutes or more. Information obtained from interview with Administrator, Mike McCoy stated he was not advised of any issues or concerns regarding R1 needing assistance. It was advised that at the time of admission, R1 was independent and did not require assistance with toileting. Information obtained from staff interviews stated that they see R1 two to three times a week and that R1 has not shared with them that they were left unattended while in the restroom. Information obtained from interview with R1 stated that they can still use the restroom without assistance and that they did not recall pressing the call pendant while on the toilet. An interview with R1’s Hospice Nurse was conducted and advised that R1 is seen two to three times a week and R1 did not inform them of any issues or concerns regarding need assistance with toileting. A review of R1’s Admission Agreement confirmed there were no notations indicating R1 required assistance with toileting needs. LPA’s review of the records verified that R1 was not incontinent at time of admission or requested assistance with toileting services during placement.
Regarding the allegation staff did not answer resident’s call button in a timely manner, it was reported that it takes an extended amount of time for facility staff to answer the call button. Information obtained from interview with the Administrator stated R1 has not brought it to management’s attention that R1 pressed their call pendant and that no caregiver responded. Information obtained from interviews with facility staff and was advised that R1 did not advise of any concerns. Staff stated call buttons are answered as quickly as possible. Information obtained from interview with R1 stated they do not recall utilizing the call button and not receiving assistance.
Regarding the allegation staff do not meet resident’s dietary needs, information obtained from interview with Administrator advised that R1 does not have any type of special diet and no food restriction that the management team is aware of. Additional information obtained from interview with facility staff advised that R1 eats solid foods and does not require a special diet. LPA observed R1 in the dining hall on eating solid foods. LPA conducted a review of R1’s Physician’s Report and there were no information regarding R1 requiring a special diet.
Based on interviews, record reviews, and observations, the allegations that staff do not meet resident's dietary needs, staff did not meet resident's toileting needs, and staff did not answer resident's call button in a timely manner, are unsubstantiated. A finding of unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur.
An exit interview was conducted, and a copy of this report was explained and provided to Business Office Manger, Jhonalyn Libunao.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
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)

Page: 2 of 2