374604544-4-2-2024-08-AS-SJAB-D3YLSZ-20240403090134

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604544
Report Date: 04/02/2024
Date Signed: 04/02/2024 02:23:21 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
01/12/2024 and conducted by Evaluator Alyssa Ramirez

COMPLAINT CONTROL NUMBER: 08-AS-20240112092031

FACILITY NAME:	PACIFICA SENIOR LIVING BONITA		FACILITY NUMBER:	374604544
ADMINISTRATOR:	REBECCA TOVES		FACILITY TYPE:	740
ADDRESS:	3434 BONITA ROAD		TELEPHONE:	(619) 476-9444
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91910
CAPACITY:	145	CENSUS: 120	DATE:	04/02/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Executive Director Rebecca Toves		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not assist residents with care needs
Facility had incomplete files for residents
Staff falsified documents

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced visit to deliver findings in the above complaint allegations. LPA identified herself and discussed the purpose of the visit with Executive Director Rebecca Toves
On January 12, 2024, Community Care Licensing (CCL) received a complaint alleging facility staff do not assist residents with care needs, facility has incomplete files for residents and staff falsified documents.
During investigation, LPA Ramirez reviewed records, toured the facility and conducted interviews of staff, residents and outside sources.
It was alleged that facility staff did not assist residents with care needs. LPA’s interviews with residents revealed no concern for staff not assisting with care needs. Interviews with facility staff revealed conflicting statements about particular staff not doing their duties and revealed that other staff will take over those duties to ensure that residents are cared for. Outside Source reported no concerns for the facility.

[Continued on 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: 04/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024

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-20240112092031

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: 04/02/2024

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

[Continued from 9099]

It was alleged that facility had incomplete files for residents. LPA conducted file reviews and did not see any incomplete files. LPA received conflicting statements from staff about whether or not they have seen incomplete resident files. One staff reported seeing incomplete files but was unable to provide names of residents with incomplete files. Outside source reported no concerns for the facility.

It was alleged that facility staff falsified documents. LPA conducted file reviews and files reviewed were complete and consistent with all paperwork in the file. Physician’s names and signatures matched all documents. Interviews with facility staff did not avail any concerns for falsified documents. Outside source reported no concerns for the facility.

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. No deficiencies were cited today.

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 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: 03/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2