374604544-4-27-2023-08-AS-LTEZ-CRC2UE-20230428174212

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604544
Report Date: 04/27/2023
Date Signed: 04/27/2023 03:08:58 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
02/06/2023 and conducted by Evaluator Nacole Patterson

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230206100908

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: 104	DATE:	04/27/2023
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Emily DeLaBarre, Executive Director		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Facility staff did not meet residents' needs.
Staff did not provide quality food to residents.
Facility did not follow Covid-19 reporting requirements.
Facility elevator was inoperable.
Facility did not make basic laundry services available to residents.
Facility did not provide residents access to the internet.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Rebecca Toves, Business Office Manager, and then met with Executive Director Emily DeLaBarre.

On 2/6/23 it was alleged that facility staff did not meet residents’ needs, did not provide quality food to residents, did not follow Covid-19 reporting requirements, allowed an elevator to remain inoperable, did not make basic laundry services available to residents, and did not ensure residents had access to the internet. The Department’s investigation consisted of 3 unannounced facility tours, review of facility records, interviews with facility staff, and LPA direct observations.

Continued on LIC9099-C...

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

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 5

Control Number 08-AS-20230206100908

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: 04/27/2023

NARRATIVE

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Continued from LIC9099
Regarding the allegation, “Facility staff did not meet residents’ needs”, it was alleged that residents were waiting long periods of time for their meals to be served in the dining room and a resident who tested positive for Covid-19 was not checked on by staff during their isolation period. Regarding dining wait times, during 2 unannounced facility visits LPA observed 2 staff members serving residents in the dining room for lunch and dinner. Staff interviews revealed that on average 2 servers are scheduled for dining services, and at times an additional 3rd staff to plate food. Staff interview revealed that all kitchen staff and caregivers are cross-trained, and staff from other areas will be utilized to ensure that there are always 2 staff members serving during mealtimes. Staff interviews revealed that the facility has a 2-hour window of time for each dining service, and not all residents come down to be served meals at the same time. Records review during the timeframe of the complaint showed that there were between 2 and 5 kitchen staff scheduled each day. Regarding Covid-19 residents being tended to, staff interviews revealed that specific caregivers were assigned to Covid-19 positive residents to reduce the spread of the infection. These staff were responsible for checking Oxygen levels and temperature of the isolated residents. Staff interviews revealed that the resident in question was checked on by staff throughout their quarantine period, was being delivered 3 meals per day to their room and maintained the ability to utilize their call button for needs. Resident interviews revealed that staff checked on quarantined residents’ multiple times throughout the day, one resident stating that they were checked on too often by staff. Residents interviewed stated that facility staff followed Covid-19 protocols. Records Review showed that the resident in question was checked on at least twice per day during quarantine outside of being delivered meals. Based on the information gathered there is no evidence to support the claim that resident(s) needs were not being met by staff.

Regarding the allegation, “Staff did not provide quality food to residents”, it was alleged that the food being served at the facility was of poor quality and variety. Staff interviews revealed that the food currently being served at the facility meets Title 22 requirements, however residents have asked for more variety and have been in communication with the chef regarding dishes they want to eat. Staff interview revealed that residents have been comparing the Pacifica Senior Living Bonita menu to the menu offered by the former Licensee, which was a more extensive menu. Resident interviews were inconsistent, as some residents stated that the food is delicious, and they enjoy it. Other residents stated they want more variety and have vocalized their requests in Resident Council meetings. Resident interviews revealed that residents have been in working in conjunction with the facility chef for new food options.
Continued on LIC9099-C

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 08-AS-20230206100908

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: 04/27/2023

NARRATIVE

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Continued from LIC9099-C
All residents interviewed confirmed that the food is of good quality. On 2 unannounced facility visits LPA observed the food on residents’ plates during mealtimes to have fresh fruit and/or salad, protein, side dishes, soup, and dessert. LPA did not observe any item on any resident's plate that resembled food that had been sitting out for long periods of time and did not observe any malodors or unnatural colors that would indicate expired or rotting food. Records review of a sample month in the timeframe of the complaint showed that the facility offered the following variety for meals: 4 different breakfast entrées with 10 different side dish offerings, 27 different lunch entrees with 36 side dish offerings, 14 different soup offerings, 30 different dinner entrées with 29 different side dish offerings, 34 different dessert offerings. The facility also provides an “Always Available” menu which offers 9 different food options that residents can always request in addition to the main entrée options. Based on the information gathered there is no evidence to support the claim that residents are not being served quality food at the facility.

Regarding the allegation, “Facility did not follow Covid-19 reporting requirements”, it was alleged that the facility did not notify the Responsible Party after a resident tested positive for Covid-19. Staff interview revealed that the resident in question is their own Responsible Party and had been notified of their positive test results as isolation protocol was initiated, per infection control requirements. Staff interview revealed that no other party was notified of the resident’s medical status due to lack of authorization. Records reviewed confirmed that the resident in question is their own POA, and documents identifying this resident’s Responsible Party show “Self” and the resident’s name. Based on the information gathered there is no evidence to support the claim that the facility did follow Covid-19 reporting requirements”.

Regarding the allegation, “Facility elevator was inoperable”, it was alleged that the facility elevator was out of service for 8 weeks. Staff interviews revealed that the elevator located near the Memory Care unit was inoperable in 2022 for 1 month; however, there is a second elevator on the facility property which maintained working order. Staff interview revealed that residents maintained the ability to access all floors of the facility during the timeframe the elevator was out of service. Staff interview revealed that due to some residents having to walk a longer distance for meals while the elevator was inoperable, the facility waived the fee for meals to be delivered to residents in their rooms during this time. Resident interviews confirmed that the additional elevator was available for use during the timeframe in question.

Continued on LIC9099-C

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 08-AS-20230206100908

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: 04/27/2023

NARRATIVE

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Continued from LIC9099-C
Records reviewed showed that the facility communicated the elevator issue with residents and Responsible Parties via email and posted signs on the elevator that it was out of service; records showed that the facility also communicated to residents and responsible parties when the elevator became operational again. Based on the information gathered there is no evidence to support that the facility did not have at least one elevator accessible for use during the timeframe of the complaint.

Regarding the allegation, “Facility did not make basic laundry services available to residents”, it was alleged that laundry service at the facility was unavailable for 1 month. Staff interviews revealed that laundry services were inoperable for 1 week due to a mechanical issue that arose from the facility renovations. Staff interviews revealed that the facility offered to send laundry out to be washed for residents, at no cost, and staff continued to wash facility laundry in alternate ways such as washing it at the Laundromat. Staff interviews revealed that many family members chose to bring residents’ clothing home to wash during this timeframe. Resident interviews revealed that the facility accommodated the laundry issue and resident laundry was still being washed. Records review showed that the facility communicated the laundry issue to residents and POAs via email advising them of the situation and providing alternative options to avoid laundry service disruption. Based on the information gathered there is no evidence to support the claim that basic laundry services were not made available to residents.

Regarding the allegation, “Facility did not provide residents access to the internet”, it was alleged that Wi-Fi was unavailable to residents. Staff interviews revealed that Wi-Fi is available throughout the building but there are certain areas of the building known to have lower Wi-Fi reception. Staff interviews revealed that Internet is available to residents in all common areas of the building, and the Licensee is working on getting a stronger Wi-Fi signal for the entire property. Staff interview revealed that the Wi-Fi network and password is provided to all residents in their welcome package; if a resident loses Wi-Fi capabilities in their room, staff will attempt to troubleshoot it as a courtesy, but Wi-Fi is not promised in the Residence and Care Agreement. Records Review confirmed that residents are provided the Wi-Fi network and password in the Resident Handbook. Title 22, section 87468.2(a)(1) requires Licensees to allow residents to have “use of the internet”. The regulation does not specifically state that Wi-Fi must be made available or directly in resident rooms. LPA observed the accessibility of the Wi-Fi during an unannounced facility visit by logging into the network with the credentials provided in the Resident Handbook; LPA was able to access the internet. There is no evidence to support that the facility was not providing resident(s) access to the internet.
Continued on LIC9099-C

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 08-AS-20230206100908

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: 04/27/2023

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 LIC9099-C Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the 6 alleged violation(s) occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Executive Director Emily DeLaBarre, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 3/22) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole Patterson	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC9099 (FAS) - (06/04)

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