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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200509
Report Date: 04/09/2026
Date Signed: 04/09/2026 02:50:49 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/06/2026 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20260406095723
FACILITY NAME:PACIFICA SENIOR LIVING UNION CITYFACILITY NUMBER:
019200509
ADMINISTRATOR:LAGASCA-CRUZ, MARIE ANNFACILITY TYPE:
740
ADDRESS:33883 ALVARADO NILES RDTELEPHONE:
(510) 489-3800
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:110CENSUS: 66DATE:
04/09/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marie Ann Lagasca-Cruz, Administrator TIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Staff do not ensure resident is provided with activities.
INVESTIGATION FINDINGS:
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On 4/9/26 at 9AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct 10-day initial complaint and deliver findings for the above allegations. LPA met with Executive Director, Marie Lagasca-Cruz and explained the purpose of the visit.

Allegation: Staff do not ensure resident is provided with activities - Unsubstantiated

During the course of the investigation, Licensing Program Analyst (LPA) conducted interviews with the Executive Director (ED), six (6) staff members, and fifteen (15) residents. The ED stated that the facility maintains a monthly activity schedule which includes, but is not limited to, group exercises, games, movie time, and community outings. Staff interviewed indicated that residents are informed of scheduled activities and are encouraged to participate; however, participation is voluntary based on resident preference.

Report Continues on LIC 9009c…
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
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 15-AS-20260406095723
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: PACIFICA SENIOR LIVING UNION CITY
FACILITY NUMBER: 019200509
VISIT DATE: 04/09/2026
NARRATIVE
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Report Continue…

LPA reviewed a sample of six (6) resident files and collected documents including, but not limited to, the staff roster with contact information, resident roster, resident admission agreements, physician reports, care plans, end-of-shift notes, and the facility activity calendar.

Additionally, LPA toured the facility including but not limited to the assisted living, memory care unit, activity room and common areas. During the visit, LPA observed that both the assisted living unit and memory care unit were actively engaged in scheduled activities.

LPA interviewed six (6) staff and fifteen (15) residents. Staff reported that residents are informed of scheduled activities, encouraged to participate, and offered assistance as needed; however, participation is voluntary and based on individual resident preference. Residents provided mixed responses. Some residents reported that they are aware of and participate in activities offered at the facility and expressed satisfaction with the variety and frequency. Other residents indicated that they choose not to participate or prefer to engage in independent activities such as watching television, reading, or resting in their rooms. No residents reported being prevented from participating in activities or stated that staff refused to provide access to activities.

Additionally, LPA interviewed Resident 1 (R1), who was observed smiling, moving R1 head, and appearing to enjoy music during the visit. When asked whether staff check in and inform R1 about activities, R1 responded “yes.” R1 also confirmed that staff offer to engage in activities, inform R1 about scheduled activities, and that R1 enjoys listening to music.

In addition, LPA reviewed the facility’s activity schedule and observed posted activity calendars in common areas. Documentation reviewed supports the idea that activities are planned and made available to residents on a regular basis.

Although some residents expressed personal preferences not to participate, there is insufficient evidence to support the claim that staff failed to ensure activities were provided. Therefore, the allegation is unsubstantiated at this time.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2