374604544-6-18-2024-08-AS-SJAB-D6FRSS-20240621131713

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604544
Report Date: 06/18/2024
Date Signed: 06/18/2024 10:51:14 AM

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
05/29/2024 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20240529112342

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:	06/18/2024
		UNANNOUNCED	TIME BEGAN:	09:11 AM
MET WITH:	Rebecca Toves		TIME COMPLETED:	11:01 AM

ALLEGATION(S):

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Facility in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced visit to deliver investigative findings. LPA was granted entry into the facility and met with Executive Director Rebecca Toves to whom LPA explained the purpose of the visit.

Community Care Licensing (CCL) has investigated the above listed complaint allegation. The investigation consisted of LPA direct observation, records review and interviews with staff and residents.

It was alleged that the facility was in disrepair. It was reported to CCL that Resident 1 (R1)(an LIC 811 Confidential Names List was provided to the facility representative to identify the resident) had a broken window. It was also reported that residents have broken toilets and clogged sinks throughout the facility. LPA visit to the facility on May 30, 2024 revealed a broken window in R1's room. LPA interviewed R1 on May 30, 2024 and June 18, 2024. R1 was not able to state how or when the window in R1's bedroom was broken. R1 stated that R1 was informed by facility staff that the window was broken.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

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-20240529112342

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: 06/18/2024

NARRATIVE

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Records review dated May 28, 2024 revealed online communication with a glass repair company regarding the replacement of R1's window. An invoice dated May 31, 2024 revealed the window was scheduled to be repaired on June 5, 2024. LPA direct observation on June 18, 2024 revealed R1's window was repaired and there were no unresolved maintenance issues in R1's room.

During LPA's visit to the facility on May 30, 2024, LPA visited three (random) resident rooms and inspected the sinks, toilets and bathtubs. LPA did not encounter any clogged sinks, bathtubs or broken toilets. LPA found all of the sinks, tubs and toilets to be functioning as normal.

Interview with Executive Director (ED) revealed R1 threw something at R1's bedroom window causing it to "spider" but not completely shatter on approximately May 26, 2024. ED stated that she has been in contact with several glass repair companies. ED stated that the facility had been without a maintenance worker for approximately one month. ED stated that during that time period they received maintenance staff assistance from their "sister facility" and from "corporate." ED stated that they currently have a maintenance applicant that has been hired and passed the background check. ED further stated that this new maintenance worker will start after he has gone through the on-boarding process.

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

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

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

LIC9099 (FAS) - (06/04)

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