374604177-9-21-2023-08-AS-DPOL-CW3T2U-20230927142120

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604177
Report Date: 09/21/2023
Date Signed: 09/21/2023 08:55:45 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
09/06/2022 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20220906115052

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:	DATE:	09/21/2023
		UNANNOUNCED	TIME BEGAN:	08:54 AM
MET WITH:			TIME COMPLETED:	08:55 AM

ALLEGATION(S):

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Staff are not meeting needs of resident(s)

INVESTIGATION FINDINGS:

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On September 6, 2022, it was alleged that staff are not meeting needs of resident(s). The Department investigated the complaint allegation. The investigation consisted of a tour of the facility, interviews with staff, residents, and records review.

Staff 1 (S1) stated the pendent is auto voice and will notify all staff with radios which room is in need of assistance. Once the staff member reaches the room, there is a check button in the room that the staff press to release the activation and records the time it took for staff to respond. The response time in which the administrator states is reasonable is 10-15 minutes. The administrator stated that the Assisted Living residents are considered low level care. Interview with staff and outside sources stated that Resident 1 (R1) did not use walker regularly and would lose their balance and lived on the independent side of the facility. R1 had transitioned to a rehab for long-term care placement.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

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-20220906115052

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PACIFICA SENIOR LIVING BONITA	FACILITY NUMBER: 374604177
	VISIT DATE: 09/21/2023

NARRATIVE

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Review of Records for Alarm Events Report and Staff Schedule 08/01/22 to 09/16/2022. Resident 1 (R1) had 6 pendent calls for this time frame, the longest wait time for clearing was 49 minutes. Staff schedule records indicated an average of 10 to 13 staff per day for personal care and medication dispersing to attend to resident needs. Per the admission agreement "Repeated use of emergency resident alert call systems for non-emergency purposes after having been given a written warning, may results in the residents eviction from the Community, or re-assessment to a higher level of care." This policy was dated 05-16-2022. No records to support resident had repeatedly used the pendent call for non-emergency use.

There was insufficient evidence found to support the allegations that staff are not meeting needs of resident(s) Due to a lack of evidence, the allegations are deemed to be unsubstantiated. A finding that is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

A copy of this report and Licensee's Rights (LIC 9058 03/22) were mailed to the last known address for the facility.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC9099 (FAS) - (06/04)

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