374604544-9-23-2024-08-AS-SJAB-D9FUQX-20240925154753

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604544
Report Date: 09/13/2024
Date Signed: 09/23/2024 10:56:48 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
07/21/2024 and conducted by Evaluator Alyssa Ramirez

COMPLAINT CONTROL NUMBER: 08-AS-20240721221122

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: 123	DATE:	09/13/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Executive Director Rebecca Toves		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff are withholding food from a resident
Staff are retaliating against a resident

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 are withholding food from a resident and staff are retaliating against a resident.

Regarding the allegation, staff are withholding food from a resident (R1), it was reported that a resident was not being provided their usual food allotment. LPA observations revealed that facility had sufficient food supply.

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: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

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-20240721221122

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: 09/13/2024

NARRATIVE

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Interview’s with staff reported that all residents are fed and no one goes without food. Staff reported that residents can either go to the dining room for meals or can get tray service per resident request. Interview with resident’s revealed that meals are always provided by the facility. Interview with R1 revealed, that facility provides R1 with all meals daily. R1 reported that they have never been denied food by staff at the facility.

Regarding the allegation, staff are retaliating against a resident (R1), it was reported that staff were mad at R1 because a staff was let go because of R1 and as a result R1 was not being given typical food allotment. Interview with R1 revealed that they have not had any staff retaliate against them or treat them unfairly. Interview’s with facility staff revealed that R1 had been exhibiting paranoia and had been requested doctor evaluate them. Facility staff reported that R1 had made comments about staff “out to get them”. Facility staff reported that no one was fired and there was a staff that took a long vacation and returned to the facility. Interview’s with residents revealed that no one has experienced retaliation from staff. Interview’s with outside sources revealed no concerns.

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 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: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

LIC9099 (FAS) - (06/04)

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