374604177-4-28-2023-08-AS-LTEZ-CRCQWB-20230429123137

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604177
Report Date: 04/28/2023
Date Signed: 04/28/2023 06:15:55 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
08/25/2022 and conducted by Evaluator Nacole Patterson

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20220825133236

FACILITY NAME:	PACIFICA SENIOR LIVING BONITA		FACILITY NUMBER:	374604177
ADMINISTRATOR:	LEON II, RENE		FACILITY TYPE:	740
ADDRESS:	3434 BONITA ROAD		TELEPHONE:	(619) 476-9444
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91910
CAPACITY:	0	CENSUS: 0	DATE:	04/28/2023
		UNANNOUNCED	TIME BEGAN:	05:42 PM
MET WITH:	Facility Closed- Report Mailed to Address on File		TIME COMPLETED:	05:43 PM

ALLEGATION(S):

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Resident sustained pressure injuries while in care
Staff did not meet resident's incontinence needs
Unlawful eviction
Staff did not assist resident with medication as prescribed
Staff did not meet resident's dietary needs
Facility did not allow resident to have visitor
Staff did not keep resident's bathroom clean

INVESTIGATION FINDINGS:

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The following determination of findings has been made by Licensing Program Analyst (LPA) Nacole Patterson regarding the above allegations. The facility closed on January 20th, 2023, due to a change of ownership, and this report was mailed to the last known address on record for the former licensee regarding the findings.

On 8/25/22 it was alleged that a resident sustained pressue injuries while in care, a resident was unlawfully evicted, staff did not meet a resident’s incontinence needs, staff did not assist a resident with medications as prescribed, staff did not meet a resident’s dietary needs, the facility did not allow a resident to have a visitor, and staff did not keep a resident’s bathroom clean. The Department’s investigation consisted of 3 unannounced facility tours, review of facility and outside source records, interviews with facility staff and outside sources, and LPA direct observations.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

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 4

Control Number 08-AS-20220825133236

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PACIFICA SENIOR LIVING BONITA	FACILITY NUMBER: 374604177
	VISIT DATE: 04/28/2023

NARRATIVE

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Continued from LIC9099

Regarding the allegation “Resident sustained pressure injuries while in care”, it was alleged that a resident developed bed sores due to staff not tending to their incontinence care needs. Interviews conducted with staff revealed that the resident did not sustain any type of pressure injuries while in care at the facility but was admitted with pressure sores, which the facility attempted to resolve. Records reviewed revealed a documented pressure ulcer by a physician that preceded the resident’s admission to the facility. No documents reviewed in the resident’s file noted that incontinence care was not being provided by staff.

Regarding the allegation, “Staff did not meet resident's incontinence needs”, it was alleged that staff did not bathe a resident, resulting in medical issues in the perineal area. Staff interview revealed that the resident in question was to receive 6 showers per week, but the resident would decline to take showers multiple times per week, which is a personal right. Records review revealed that family members of the resident in question prevented certain staff members from providing showers to the resident as well as grooming care. Records review confirmed that the facility agreed to provide 6 showers per week to the resident and staff members were aware of this expectation. No records reviewed revealed that incontinence care and bathing assistance were not being provided or attempted by staff.

Regarding the allegation, “Unlawful Eviction”, it was alleged that the facility attempted to evict a resident without proper notice. Staff interviews revealed that the resident in question was moved by the Responsible Party due to needing a higher level of care that the facility was not able to provide. Records reviewed revealed that the Responsible Party was actively looking for another facility for the resident to be placed, and the facility continued to care for the resident until a new placement was found. No records reviewed indicated that the resident was evicted unlawfully.

Regarding the allegation, “Staff did not assist resident with medication as prescribed”, it was alleged that staff administered a medication to a resident after it was discontinued by the resident’s doctor. No staff interviewed had knowledge of the resident in question being given discontinued medication. Electronic Medication Administration records were inaccessible to be reviewed due to the facility undergoing new ownership and no longer having access to the electronic record. No records reviewed in the physical file indicated that the resident in question was being given a discontinued medication.

Continued on LIC9099-C

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20220825133236

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PACIFICA SENIOR LIVING BONITA	FACILITY NUMBER: 374604177
	VISIT DATE: 04/28/2023

NARRATIVE

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Continued from LIC9099-C

Regarding the allegation, “Staff did not meet resident's dietary needs”, it was alleged that facility staff did not ensure a resident was assisted with their meals each day. Staff interviews revealed that dynamic issues were at play with the resident’s family that resulted in the resident intentionally not eating when certain family members were present. Staff interview revealed that, when comfortable, the resident would typically eat until satiated and their eating patterns were consistent. Staff interview revealed an agreement for the facility to provide photographic proof that the resident was being assisted with meals daily, which the facility adhered to. No records reviewed in the physical file indicated that the resident in question was not being offered food or assisted with their dietary needs by facility staff.

Regarding the allegation, “Facility did not allow resident to have visitor”, it was alleged that the facility was restricting family visitation for a resident. Staff interview revealed that certain visitors of the resident in question were in violation of the visitation policy in the Residence and Care Agreement, signed by the Responsible Party. Staff interview revealed that the facility exercised its right to remove or deny entry into the facility to a disruptive visitor. Records Review revealed an incident where the local police department was called to the facility due to disruptive and aggressive behavior toward staff members by a visitor of the resident in question. No other records reviewed revealed that facility staff restricted visitation for the resident in question.

Regarding the allegation, “Staff did not keep resident's bathroom clean”, it was alleged that staff did not clean a resident’s toilet for 2 weeks. Staff interviews revealed that the resident in question’s room was cleaned according to the housekeeping schedule outlined in the Residence and Care Agreement signed by the Responsible Party. No staff interviewed had knowledge or observation of the toilet in question not being clean. Staff interview revealed that the room in question was occupied by two residents, and the second resident did not express concern regarding improper cleaning in the bathroom. Staff interview revealed that residents and staff could make a request to housekeeping for additional cleaning services when needed.

Continued on LIC9099-C

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 08-AS-20220825133236

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PACIFICA SENIOR LIVING BONITA	FACILITY NUMBER: 374604177
	VISIT DATE: 04/28/2023

NARRATIVE

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Continued from LIC9099-C

Review of the Resident Services Agreement showed that resident apartments were cleaned on a weekly basis unless the resident opted to pay for additional cleaning services. No records reviewed indicated that the room in question was to receive additional cleaning services. Records reviewed showed that weekly cleaning service included vacuuming, dusting, trash removal, and bathroom cleaning, while beds were made daily. Records reviewed during the timeframe of the complaint showed that the room in question was cleaned each Monday. No records reviewed showed that the resident in question made known any issues regarding the cleanliness of their bathroom and/or requested additional cleaning services from housekeeping staff.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the 7 alleged violation(s) occurred, therefore the allegations are UNSUBSTANTIATED. A copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were mailed to the last known address on file.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

LIC9099 (FAS) - (06/04)

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