374604544-4-30-2024-08-AS-LTEZ-D5KSG2-20240524135113

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604544
Report Date: 02/28/2024
Date Signed: 04/30/2024 01:39:31 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
02/22/2024 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20240222151847

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: 117	DATE:	02/28/2024
		UNANNOUNCED	TIME BEGAN:	10:38 AM
MET WITH:	Ana Solis, Business Office Manager Rebecca Toves, Executive Director		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Facility retained resident not appropriate for facility
Facility had uncleared staff

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to open a complaint and deliver findings. LPA was allowed entry by Ana Solis, Business Office Manager. The interview was later joined by Rebecca Toves, Executive Director. LPA identified herself and disclosed the purpose of the visit and elements of the findings to the Business Office Manager and the Executive Director.

On February 22, 2024, the Department received allegations that a resident residing in the facility was not appropriate for the level of care provided by the facility. Additionally, there were claims that the facility had uncleared staff working with residents. This investigation report aims to address these allegations and determine the validity of the claims.

The LPA conducted interviews with staff members and outside sources. A review of the resident's medical records and care plans and toured the facility
{Continued on 9099C}amended report at 12:22 pm to include additional Resident (R2)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024

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-20240222151847

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: 02/28/2024

NARRATIVE

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1. Resident Appropriateness: After reviewing the resident's medical records and care plans, it was determined that the resident was appropriate for the level of care provided by the facility. The resident's needs were being met, and there were no indications that the resident required a higher level of care before hospitalization. It was determined before release from the hospital that the resident needed a higher level of care. The family member did not want the resident to go to a Skilled Nursing Facility (SNF). As of February 22, 2024, the resident is no longer residing at the facility. The family member retrieved the resident's belongings. The resident was hospitalized on February 14, 2024, directly from an appointment with dialysis. Resident 2 (R2) was deemed appropriate for the facility at Level 1 based on the assessment conducted before move-in to the facility. R2 was diagnosed with aphasia s/p stroke, which caused communication limitations for R2. The staff interviewed did not deem R2's behavior as "aggressive" but as frustration due to limited communication.

2. Staff Clearance: All staff members working with residents had undergone the necessary background checks and clearance processes as per the facility's policies and procedures. No uncleared staff members were working with residents at the time of the investigation.

Based on the findings of the investigation, the allegations that the facility retained a resident who was not appropriate for the level of care provided and had uncleared staff working with residents are unsubstantiated.
A finding that is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted with Rebecca Toves, Executive Director. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Executive Director and her signature on this report confirms receipt of the Licensee Rights.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024

LIC9099 (FAS) - (06/04)

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