374604539-2-5-2024-08-AS-JLOT-D2GV6S-20240215150957

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604539
Report Date: 02/05/2024
Date Signed: 02/05/2024 03:43:53 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
01/31/2024 and conducted by Evaluator Nacole Patterson

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20240131163717

FACILITY NAME:	PACIFICA SENIOR LIVING ENCINITAS		FACILITY NUMBER:	374604539
ADMINISTRATOR:	WATKINS, MELISSA		FACILITY TYPE:	740
ADDRESS:	504 S EL CAMINO REAL		TELEPHONE:	(760) 452-0615
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY:	90	CENSUS: 52	DATE:	02/05/2024
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Executive Director Melissa Watkins		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

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Licensee did not address elevator in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to initiate a complaint investigation and deliver findings regarding the above complaint allegation. LPA introduced herself and disclosed the purpose of the visit to Executive Director Melissa Watkins.

On 2/1/24 the allegation, "Licensee did not address elevator in disrepair" was made against the facility. The Department’s investigation consisted of an unannounced facility visit, review of facility and outside source records, interviews with facility staff, residents, outside sources, and LPA direct observations. Staff interview revealed that the elevator was put out of service by the Department of Industrial Relations, Division of Occupational Safety and Health for approximately one (1) week, due to a smoke detection issue. Staff interview revealed that the Licensee immediately contacted elevator service contractors to resolve the issue, which was corroborated by outside source interviews and facility records. Staff interview further revealed that staff communicated the issue to residents and continued to meet their needs by utilizing evacuation stairwell chairs, creating a temporary dining room on the second floor, and duplicating activities for 2nd floor residents. (Continued on LIC9099-C p.2)

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: 02/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2024

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-20240131163717

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 ENCINITAS	FACILITY NUMBER: 374604539
	VISIT DATE: 02/05/2024

NARRATIVE

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(Continued from LIC9099 p.1)

Residents interviewed did not have concerns regarding how the Licensee assisted them during the elevator outage. Residents stated that staff did a good job continuing services and noted that staff worked very hard to make sure resident needs were met. Outside source interviews and records showed that the elevator was put out of service on 1/24/24, and Licensee made arrangements with three (3) different contractors to fix the elevator on 1/25/24, 1/26/24, 1/28/24, 1/29/24, 1/30/24, and 1/31/24. Outside sources confirmed that the elevator was placed back in service on 2/1/24, approval granted by the Department of Industrial Relations. During an unannounced facility visit LPA directly observed the elevator in working order and the signs used to communicate to residents when it was out of order.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the Licensee did not address elevator in disrepair, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Executive Director Melissa Watkins, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2024

LIC9099 (FAS) - (06/04)

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