374604544-5-24-2023-08-AS-DPOL-CSCL2M-20230531082235

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604544
Report Date: 05/24/2023
Date Signed: 05/24/2023 03:43:25 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/14/2023 and conducted by Evaluator Carmen Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230314092520

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: 107	DATE:	05/24/2023
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Emily DeLaBarre, Executive Director		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

- Staff did not meet residents care needs.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to deliver investigation findings. LPA identified herself and was granted entry by Christine Quiros, Receptionist. LPA stated the purpose of the visit and reviewed the findings of the complaint with Executive Director Emily DelaBarre.

The Department’s investigation consisted of interviews with staff, outside sources and residents, records review of relevant documents pertinent to this investigation, and LPA observations. On March 14, 2023, it was alleged that the staff did not meet the residents care needs.

Interviews with residents confirmed there were times when there are insufficient staff to assist residents timely, especially since the facility is large and there are very few caregivers. Residents said that staff do tend to take a while in responding to a resident’s call. Staff interviews confirmed that there are insufficient staff to meet the needs of residents.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

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 3

Control Number 08-AS-20230314092520

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PACIFICA SENIOR LIVING BONITA	FACILITY NUMBER: 374604544
	VISIT DATE: 05/24/2023

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

Staff confirmed that it typically took approximately 30 minutes, to respond to residents, especially when they are assisting other residents. A review of facility records showed resident #1 (R1) Physician’s Report dated July 2021 revealed that R1 was independent and needed no assistance with transferring. However, during staff interviews, it was revealed that R1 needed a reassessment to be completed to show R1 needed a higher level of care that included assistance with transferring. Staff schedules showed there were three working shifts for each unit, assisted living and memory care. The first shift for the assisted living unit, 6:00 AM – 2:00 PM, typically scheduled two personal care assistants and one medication technician. It was infrequent to see two medication technicians assigned with two personal care assistants during the same shift. The following shift, 2:00 PM – 10:00 PM, usually had two personal care assistants and one medication technician scheduled. Schedules showed one medication technician and one personal care assistant scheduled at least twice per week. The last scheduled shift, 10:00 PM – 6:00 AM, only had one medication technician and one personal care assistant scheduled twice per week and only one medication technician the remaining of the week. There were times on the schedule that there were no medication technicians or personal care assistants scheduled in the assisted living unit on the last shift. During the visit on March 21, 2023, the current resident census was 97; 16 residents in the memory care unit and 81 residents in the assisted living unit. There were six residents who were on hospice services. When LPA toured the facility, LPA observed only one caregiver in sight on the second floor assisting a resident with their meal. Once that caregiver left, there were no other staff observed in the vicinity. LPA was able to tour the area for approximately 30 minutes. LPA observed a resident attempting to leave their room who needed assistance with no staff to assist. LPA was able to assist resident to keep their door ajar while they exited their room. There was a second resident who needed assistance with finding the elevator and looked for an elevator or staff to assist. LPA guided the resident to the elevator as there were no staff present. Based on the information obtained, there is sufficient evidence to support the allegation.

Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during staff and resident interviews, records reviewed, and LPA observations, there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegation is deemed to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC9099D.

The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with Executive Director Emily DelaBarre. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Executive Director DelaBarre at the conclusion of the visit. The signature below confirms the receipt of these documents.

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20230314092520

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PACIFICA SENIOR LIVING BONITA	FACILITY NUMBER: 374604544
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/24/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/07/2023 Section Cited CCR 87468.2(a)(4)	1 2 3 4 5 6 7	87468.2 Personal Rights of Residents in Privately Operated Facilities (a)(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs… this requirement was not met as evidence by:	1 2 3 4 5 6 7	Facility will be hiring one extra personal care assistant for each shift and will submit a care staff assignement sheet to verify the onboarding of additional staff to LPA by POC due date, 6/07/23.
	8 9 10 11 12 13 14	Based on interviews, records review, and observations, facility did not provide sufficient staff to meet resident’s care needs. This posed a potential personal rights risk to [R1] 1 of 97 residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3