374604177-9-21-2023-08-AS-DPOL-CW3T4R-20230927142423

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604177
Report Date: 09/21/2023
Date Signed: 09/21/2023 09:34:02 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
01/09/2023 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20230109124926

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:	09:10 AM
MET WITH:			TIME COMPLETED:	09:11 AM

ALLEGATION(S):

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Residents left unsupervised by staff for an extended period of time
Staff mismanaged resident's medicaton
Staff on duty was providing care without current first aid/CPR certification

INVESTIGATION FINDINGS:

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On January 9,2023 a complaint was received regarding the alleged incidents of residents being left unsupervised by staff for an extended period of time, staff mismanagement of medication, and staff on duty was providing care without current first aid/CPR certification at Pacifica Senior Living Bonita. The purpose of the investigation was to determine the validity of the allegations and take appropriate actions if necessary.

Allegation 1: Residents Left Unsupervised the complaint alleged that residents were left unsupervised by staff for an extended period of time, potentially compromising their safety and well-being. The complainant did not provide any specific instances where they witnessed residents being left alone in common areas without any staff present.

Continued on 9099 C

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-20230109124926

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 facility documentation of shift schedules, did not reveal any significant discrepancies or patterns indicating a consistent lack of supervision during the alleged incident.

Allegation 2: Staff Mismanagement of Medication; The complaint alleged that staff mismanaged residents' medication, potentially compromising their health and safety. The complainant did not provided specific instances where they observed staff members administering incorrect dosages or administering medication at incorrect times. Review of medication administration records and incident reports did not revealed any instances where medication errors occurred.

Allegation 3: Staff on Duty without Current First Aid/CPR Certification; The complaint alleged that staff members were providing care without current first aid/CPR certification. The complainant did not provided any specific instances where they witnessed staff members responding to emergencies without demonstrating proper first aid/CPR techniques. Review of training records revealed that all staff members who were required to maintain current first aid/CPR certifications completed the necessary training.

Based on review of documentation, the allegations of: residents being left unsupervised by staff for an extended period of time, staff mismanagement of medication and staff providing care without current first aid/CPR certification is unsubstantiated due to a lack of conclusive evidence. 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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