374604544-10-20-2023-08-AS-DPOL-CX5VBP-20231031161751

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604544
Report Date: 10/20/2023
Date Signed: 10/20/2023 04:32:07 PM

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
10/05/2023 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20231005114844

FACILITY NAME:	PACIFICA SENIOR LIVING BONITA		FACILITY NUMBER:	374604544
ADMINISTRATOR:	MARKOVICH, PAUL		FACILITY TYPE:	740
ADDRESS:	3434 BONITA ROAD		TELEPHONE:	(619) 476-9444
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91910
CAPACITY:	145	CENSUS: 113	DATE:	10/20/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Resident Services Director, Jenifer Brown		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff inappropriately touched resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint visit to deliver investigative findings. LPA met with Jenifer Brown, Resident Services Director, and shared findings.

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

On October 5, 2023, Community Care Licensing (CCL) received a complaint alleging that a facility staff (S1) inappropriately touched a resident (R1), [an LIC 811 Confidential Names List was provided to staff to identify the resident and staff]. On September 19, 2023, R1 communicated that S1 had touched their “private area” inappropriately. Facility staff immediately reported the incident to law enforcement.

(continue at LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

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 2

Control Number 08-AS-20231005114844

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: 10/20/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continue from LIC 9099

A review of law enforcement incident report indicated that they were not able to establish mistreatment or abuse of R1 based on the information provided. A detailed review of R1’s medical records and service care plan indicated that R1 had a diagnosis of dementia and was prescribed medication to suppress pain and erratic behaviors.

Statements obtained by law enforcement, outside sources, and staff regarding the alleged incident during interviews with R1 were inconsistent due to their dementia. During a visit to the facility conducted on October 10, 2023, R1 was not available for an interview. A review of camera footage during the time frame of the alleged incident, seen by outside sources and facility staff did not show any questionable or suspicious activity. The video footage as reported by outside sources and facility staff showed S1 performing incontinence care to R1, as required in R1’s service care plan. The video footage was not available for review during the investigation. A review of S1’s personnel records did not indicate any disciplinary actions or misconduct. During interviews, S1 denied the allegation and stated that they were conducting routine incontinence care following normal procedures as part of their job responsibilities. After the incident, as an extra precautionary measure, facility staff instituted two-person assist for R1 when conducting incontinence care. Based on record reviews and interviews with staff and outside sources, there was insufficient evidence to support the allegation that S1 inappropriately touched R1.

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 Resident Services Director, Jenifer Brown, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) was provided at the conclusion of the visit.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2