374604544-12-27-2023-08-AS-SJAB-CYWVJM-20231227152859

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604544
Report Date: 12/27/2023
Date Signed: 12/27/2023 10:04:10 AM

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
11/06/2023 and conducted by Evaluator Alyssa Ramirez

COMPLAINT CONTROL NUMBER: 08-AS-20231106122214

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: 110	DATE:	12/27/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Executive Director Rebecca Toves		TIME COMPLETED:	09:00 AM

ALLEGATION(S):

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Staff did not follow universal precautions

Staff are not isolating residents with infectious diseases

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced complaint visit to deliver findings on the above allegations. LPA met with Executive Director Rebecca Toves and discussed the purpose of the visit and elements of the complaint.

Community Care Licensing (CCL) has investigated the above allegations. The investigation consisted of records review, interviews with facility staff, clients and outside agency.

It was reported to CCL that staff do not follow universal precautions for COVID and staff are not isolating residents with infectious diseases.

[Continued on LIC 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Alyssa Ramirez	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

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-20231106122214

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 BONITA	FACILITY NUMBER: 374604544
	VISIT DATE: 12/27/2023

NARRATIVE

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[Continued from LIC 9099]

LPA’s interview with Executive Director and Resident Services Director revealed that there was a COVID outbreak in the facility with approximately sixteen (16) residents affected. They reported that the facility has a COVID mitigation plan and it was followed.

They reported that residents who tested positive for COVID were asked to isolate for five (5) days and if after five days if the resident still had symptoms they were asked to continue to isolate until they have no symptoms. They stated that signage was placed outside positive resident’s doors and PPE was left outside the bedrooms. Positive residents all had a designated caregiver who monitored their symptoms. During the outbreak there was no communal dining, and they utilized cart service for meals. All staff, physician’s and responsible parties were notified of the outbreak and the change in dining services.

Interviews with facility staff revealed that staff were aware of the outbreak and protocol’s were followed. Staff reported that positive residents isolated, all parties were notified, and PPE was provided.

LPA reviewed facility records, including facilities’ COVID mitigation plan and COVID positive residents daily notes that showed that facility followed COVID protocols.

Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid.

An exit interview was conducted with Executive Director Rebecca Toves. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Executive Director Rebecca Toves whose signature below verifies receipt of these rights.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Alyssa Ramirez	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

LIC9099 (FAS) - (06/04)

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