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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604544
Report Date: 09/26/2023
Date Signed: 09/26/2023 08:45:17 PM

Substantiated


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
07/25/2023 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20230725085018
FACILITY NAME:PACIFICA SENIOR LIVING BONITAFACILITY NUMBER:
374604544
ADMINISTRATOR:MARKOVICH, PAULFACILITY TYPE:
740
ADDRESS:3434 BONITA ROADTELEPHONE:
(619) 476-9444
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:145CENSUS: 111DATE:
09/26/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Business Office Manager, Rebecca TovesTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Staff did not follow food sanitation practices
Not sufficient staff scheduled to meet the needs of residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to deliver investigative findings. LPA met with Executive Director, Emily De La Barre, and shared findings.

The Department investigated the above-listed complaint allegations. The investigation consisted of multiple inspections of the specific areas in the facility, observations, multiple interviews with staff, and a detailed review of relevant records.

On July 25, 2023, Community Care Licensing (CCL) received a complaint alleging that staff did not follow food sanitation practices. It was specifically alleged that food handlers did not wear hair nets or gloves.

During multiple visits conducted on 8/2/2023, kitchen staff were observed not wearing hair nets or gloves. During this initial visit, the cook was observed wearing a hat in lieu of wearing a hair net. In addition, while cooking food the cook was observed handling their hat repeatedly without changing their gloves risking food cross-contamination. During this visit, staff were advised that hair nets were necessary items and were good business practices and required by the FDA and USDA in food handling settings. Staff were also reminded that Title 22 regulations require food handlers to wear protective equipment when handling food for residents.
(Continue at LIC9099C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
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 6
Control Number 08-AS-20230725085018
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: 374604544
VISIT DATE: 09/26/2023
NARRATIVE
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Continue from LIC9099
The same observations were made during subsequent visits conducted on 8/23/2023, 8/31/2023 and 9/13/2023. Facility management indicated that they were not aware that kitchen staff continued not to be in compliance. During staff interviews, it was indicated that the facility inventory for these items had run out. Management indicated that purchase orders had been placed and was unaware the merchandise had not arrived. On September 13, 2023, management went out to purchase enough supplies and instructed kitchen staff to immediately start using the protective equipment as required.

It was also alleged that sufficient staff were not scheduled to meet residents’ needs. Based on the review of the assignment sheets for the months of July and August 2023 it appears that for the most part, there were enough caregivers scheduled to work per shift. However, there were times when caregivers called out and it wasn't clear which caregiver provided coverage on that particular day or if coverage was provided.

During a visit conducted on 9/13/2023, 9:45 am, LPA observed that staffing during the morning shift on this day was not sufficient to meet residents' needs. It was observed that there was only one caregiver and one medication technician to meet the needs of 98 residents in Assisted Living. In addition, both the Executive Director and the Resident Services Director were not present at the facility. The Sales Director was also out and not available. There were no management staff present at the facility. During the visit, approximately at noon, the Executive Director arrived at the facility to provide coverage as a caregiver until the staffing level was back to normal during the afternoon shift which started at 2:00 p.m. The Executive Director indicated that they had unanticipated callouts and there were no available caregivers to provide the necessary coverage. The Executive Director stated she was telecommuting doing training and was available via telephone and informed of the staffing situation and came in to provide coverage. The Executive Director indicated the Resident Services Director was out on leave. During staff interviews, it was indicated that the facility was not contracted with a temporary agency for caregivers. In addition, during interviews with staff and outside sources, it was indicated that at times when caregivers call out unexpectedly or are out due to an illness there were no available caregivers in the employee roster to provide the needed coverage. Staff also indicated that caregivers would need to work double shifts due to understaffed conditions. Based on observations on 9/13/2023, the staffing level for care staff was not sufficient to meet the needs of the residents in assisted living.
(Continue at LIC9099C)
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 08-AS-20230725085018
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: 374604544
VISIT DATE: 09/26/2023
NARRATIVE
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(Continue from LIC9099C)

Based on observations, records review, and interviews with staff and outside sources, there was sufficient evidence to support both allegations in this report.

The Department has investigated the above-mentioned allegations and has found that there was sufficient evidence to corroborate the allegations. Therefore, these allegations are deemed to be substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. A Deficiency was cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on LIC 9099-D.

A copy of this report, LIC 9099D, along with Licensee/Appeal Rights (LIC 9058 03/22) was provided to Executive Director, De La Barre at the end of the visit.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 08-AS-20230725085018
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: 374604544
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2023
Section Cited
CCR
97555(b)(15)
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87555 General Food Service Requirements (b) The following food service requirements shall apply:
(15) All persons engaged in food preparation and service shall observe personal hygiene and food services sanitation practices which protect the food from contamination.

This requirement was not met as evidenced by:
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Licensee agreed to conduct additional training with food handling employees to ensure personal protective equipment is worn. Documentation of in service training will be submitted to CCL by POC date of 10-27-2023
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Based on observations, interviews with staff, and records review, the licensee did not ensure employees engaged in food preparation were wearing the appropriate personal protective equipment to prevent food cross-contamination. This posed a potential health risk to 110 residents in care.
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Type B
10/27/2023
Section Cited
CCR
87411(a)
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87411 Personnel Requirements – General
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet residents’ needs.
This requirement was not met as evidenced by:
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Licensee agreed to review their personnel/staffing requirements and update plan of operations to ensure facility personnel are sufficient in number and compentency to meet residents needs. Licensee will submit a revised plan of operations to CCL by POC date 10-27-2023.
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Based on interviews and observations, the licensee did not ensure the facility was adequately staffed to meet the needs of 110 residents. This posed a potential health and safety risk to 110 residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
07/25/2023 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20230725085018

FACILITY NAME:PACIFICA SENIOR LIVING BONITAFACILITY NUMBER:
374604544
ADMINISTRATOR:MARKOVICH, PAULFACILITY TYPE:
740
ADDRESS:3434 BONITA ROADTELEPHONE:
(619) 476-9444
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:145CENSUS: 111DATE:
09/26/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Business Office Manager, Rebecca TovesTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Staff did not provide between-meal snacks to residents
Staff did not meet residents’ hygiene needs
Staff did not follow reporting requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint visit to deliver investigative findings. LPA met with Executive Director, Emily De La Barre, and shared findings.

The Department investigated the above-listed complaint allegations. The investigation consisted of observations, a review of relevant records, and interviews with facility staff, residents, and outside sources.

On July 25, 2023, Community Care Licensing (CCL) received a complaint alleging that facility staff did not provide between-meal snacks to residents. On August 2, 2023, during a visit, the residents were observed in the activity room having an ice cream social. During interviews, multiple residents stated that during the summer they have ice cream socials 2 – 3 times per week. The residents also stated that snacks and drinks were offered during the scheduled activities daily. None of the residents indicated having problems getting snacks from the kitchen staff according to their preferences and requests.
(Continue at LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 08-AS-20230725085018
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: 374604544
VISIT DATE: 09/26/2023
NARRATIVE
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(Continue from LIC9099A)
During interviews, staff indicated that they normally offered snacks during scheduled activities and upon request. The staff indicated they keep plenty of snack supplies on hand, such as cookies, fruit, crackers, and cheese sticks were always available items upon request.

It was also alleged that staff did not meet residents’ hygiene needs. It was specifically alleged that residents were left with soiled briefs for extended periods of time. On August 2, 2023, during a visit, multiple residents were observed in the memory care unit walking or sitting in the common areas to be clean, well-groomed, and wearing appropriate clothing. During individual inspections, six (6) total assist residents' rooms were observed to be clean, organized, and free from bad odors. Although the residents could not be interviewed due to their dementia medical condition, they were also observed to be clean, well-groomed, and free from bad odors. During multiple visits conducted on 8/23/2023, 8/31/2023, and 9/13/2023 the residents were observed clean and well-groomed with no indications of hygiene neglect. Interviews with outside sources disclosed no problems with staff not meeting residents’ hygiene needs. During interviews, staff indicated that residents were checked every two hours for incontinence care and received two (2) showers per week as required in their individual service care plans.

It was alleged that staff did not follow reporting requirements. It was specifically alleged that facility management did not report to Community Care Licensing (CCL) when a memory care resident eloped. During the investigation, it was confirmed that there had been a couple of attempted elopements involving one resident. During staff interviews, it was indicated that the resident used to be an assisted living resident and was confused about wanting to go back to assisted living. Facility staff immediately redirected and guided the resident back into the memory care unit. Per Title 22 regulations, attempted elopements are not required to be reported to CCL. During staff interviews, it was indicated that the facility elopement protocols require care staff to report it immediately to management who in turn reports the incident to CCL as required per Title 22 regulations. A review of facility records indicated that the facility’s elopement procedures were in compliance with regulations.

The Department has investigated the above-mentioned allegations and based on interviews with staff, residents, and outside sources, the preponderance of the evidence has not been met, therefore, these allegations are deemed to be unsubstantiated.

An exit interview was conducted with Executive Director Emily De La Barre, to whom a copy of this report, and the Licensee Appeal Rights (LIC9058 01/16) were provided at the conclusion of the visit.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6