374604300-6-13-2023-08-AS-LTEZ-CT9V7K-20230629161115

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604300
Report Date: 06/13/2023
Date Signed: 06/13/2023 02:21:56 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/05/2023 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20230605092702

FACILITY NAME:	PACIFICA SENIOR LIVING OCEANSIDE		FACILITY NUMBER:	374604300
ADMINISTRATOR:	BANKS, JAQUELINE		FACILITY TYPE:	740
ADDRESS:	5508 AVENIDA PACIFICA WAY		TELEPHONE:	(760) 978-6602
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92057
CAPACITY:	165	CENSUS: 108	DATE:	06/13/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Executive Director Jackie Banks		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not administer medications as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to open an investigation and deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Resident Services Director Jennifer Gephart and Executive Director Jackie Banks.
During today's visit, LPA observed residents in care, interviewed staff, and obtained copies of facility records.
The Department’s investigation consisted of interviews with staff and outside sources, records review, and a tour of the facility. It was alleged that staff did not administer medications as prescribed. Review of medical documents revealed that Resident 1 (R1) was unable to store or self-administer medications. Interviews and records review revealed that in March 2023, R1 returned to the facility after receiving outside care with an updated medication list, which included the addition of a new medication.

Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

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-20230605092702

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: PACIFICA SENIOR LIVING OCEANSIDE	FACILITY NUMBER: 374604300
	VISIT DATE: 06/13/2023

NARRATIVE

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Review of faxes sent from the facility revealed that in April 2023, facility staff submitted R1’s current medication list to their primary physician with a request to review R1’s medications and issue any orders as necessary. The following day, R1’s primary physician faxed R1’s current medication list with no discontinuation orders to the facility. Interviews revealed that R1’s responsible party did not want R1 to continue taking the new medication and requested that the facility stop giving the medication to R1. Interviews revealed that facility staff, including the Resident Services Director and Executive Director, spoke with R1’s responsible party and explained that facility staff were required to follow prescribing orders and a medication can only be discontinued by a physician’s order. They also explained that residents have the right to refuse medications and cannot be forced to take any medications they do not want to. Interviews revealed that facility staff had made several fax and phone call attempts to contact R1’s physician requesting a discontinue order for the new medication. Interviews revealed that some residents’ primary physicians, including R1’s primary physician, did not respond promptly to staff’s request for updated orders, which resulted in follow-up faxes sent by facility staff. Interviews revealed that if facility staff had difficulty contacting a primary physician, staff would notify the Resident Services Director who would reach out to the primary physician and would ask the resident’s responsible party to request the discontinue order from the primary physician as well.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Executive Director Jackie Banks, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

LIC9099 (FAS) - (06/04)

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