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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507004251
Report Date: 05/17/2022
Date Signed: 05/19/2022 02:23:55 PM


Document Has Been Signed on 05/19/2022 02:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:PACIFICA SENIOR LIVING MODESTOFACILITY NUMBER:
507004251
ADMINISTRATOR:THERESA L PETTAPIECEFACILITY TYPE:
740
ADDRESS:2325 ST PAUL'S WAYTELEPHONE:
(209) 491-0800
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:73CENSUS: 38DATE:
05/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Theresa Pettapiece, Marlene Nelson, and Carl Knepler. TIME COMPLETED:
12:00 PM
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On 05/19/2022 at 10:00 AM, an office meeting was held via Microsoft Teams to discuss and deliver the findings by Department Auditors related to a complaint received by the Department on 02/2/2022. Present in this meeting were: Regional Manager Stephenie Doub, Licensing Program Manager Czarrina Camilon-Lee, Licensing Program Analyst (LPA) Avelina Martinez, Auditor Jacqueline Juarez, Auditor Benjamin Banahene; Pacifica Senior Living Management: Marlene Nelson, Sean Downey, and Carl Knepler.

On February 2, 2022, the Sacramento South Regional Office received a complaint in regards to a financial concerns at the facility, and a solvency audit was requested and conducted by the Department’s audit section. The findings of the audit are as follows:
  • Pacifica Senior Living Modesto facility does not have a sound financial plan in place.
  • Pacifica Senior Living Modesto is operating at a net loss and does not have an adequate cash reserve based on the size of the facility.
  • Pacifica Senior Living Modesto does not generate sufficient income to meet the operating costs.
  • Pacifica Senior Living Modesto did not provide all requested documents by Department and did not maintain adequate financial records.
  • Pacifica Senior Living Modesto Licensee did not exercise general supervision over the affairs of this licensed facility.

Continued...

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: PACIFICA SENIOR LIVING MODESTO
FACILITY NUMBER: 507004251
VISIT DATE: 05/17/2022
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The Licensee representatives' agreed to the following to remain in compliance:
  • The licensee shall ensure sufficient resources to meet operating costs for care of the residents until the facility is closed.

There were no citations cited at this Microsoft Virtual office meeting. However, an audit financial deficiency can be found on the February 2, 2022 complaint report. An exit interview was conducted with Theresa Pettapiece via telephone, and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022
LIC809 (FAS) - (06/04)
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