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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803645
Report Date: 08/11/2022
Date Signed: 08/11/2022 11:43:24 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/28/2022 and conducted by Evaluator Farhaan Sarangi
COMPLAINT CONTROL NUMBER: 21-AS-20220628121307
FACILITY NAME:PACIFICA SENIOR LIVING VACAVILLEFACILITY NUMBER:
486803645
ADMINISTRATOR:LEE-ALLMOND, MELODYFACILITY TYPE:
740
ADDRESS:431 NUT TREE ROADTELEPHONE:
(707) 449-1350
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:75CENSUS: 59DATE:
08/11/2022
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Administrator, Melody Lee AllmondTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Not enough staff to meet resident's needs.
Facility is odiferous.
Residents are not being provided activities while in care.
Requests for communication with staff are not being responded to in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Pacifica Senior Living Vacaville for the purpose of delivering complaint findings. LPA was greeted at the door by Administrator, Melody Lee Allmond, and was granted access into the facility.

Complaint alleges that there is not enough staff to meet resident's needs. During the course of the investigation, LPA reviewed facility records, interviewed staff, residents, witnesses, toured the facility and made observations on August 11, 2022, July 21, 2022, July 12, 2022 and June 30, 2022. LPA observed sufficient staffing during the tours of the facility. During the review of facility records, LPA learned that the facility records were appropriate, LPA could not prove or disprove that the facility does not have enough staffing to meet residents needs based off of LPA observations, interviews and review of facility records.

(Report continued on LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
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 2
Control Number 21-AS-20220628121307
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: PACIFICA SENIOR LIVING VACAVILLE
FACILITY NUMBER: 486803645
VISIT DATE: 08/11/2022
NARRATIVE
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Complaint alleges that the Facility is odiferous. During the course of the investigation, LPA toured the facility and made observations on August 11, 2022, July 21, 2022, July 12, 2022 and June 30, 2022. During those tours, LPA found the facility to be clean, sanitary and in good repair. LPA could not prove or disprove that the facility is odiferous based on observations on said dates.

Complaint alleges that the residents are not being provided activities while in care. During the course of the investigation, LPA reviewed facility records and made observations on July 21, 2022. LPA learned through the review of the Activities Menu that the facility has activities for residents. In addition, during a tour of the facility on July 21, 2022, LPA Farhaan Sarangi and Caitlynn Felias observed an activity being conducted by a staff member at the facility. Furthermore, LPA could not prove or disprove that the residents are not being provided activities while in care.

Complaint alleges that requests for communication with staff are not being responded to in a timely manner. During the course of the investigation, LPA interviewed staff, residents and witnesses and could not prove or disprove that the facility staff or Administrator are not responding to requests for communication.

A finding that the complaint allegations of, not enough staff to meet resident's needs, facility is odiferous, residents are not being provided activities and requests for communication with staff are not being responded to in a timely manner are unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview was conducted and a copy of this was report was signed and given to the Administrator.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2