019200509-4-14-2026-15-AS-BFOG-DTU2WL-20260506174539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200509
Report Date: 04/14/2026
Date Signed: 04/14/2026 02:44:55 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
04/09/2026 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20260409145528

FACILITY NAME:	PACIFICA SENIOR LIVING UNION CITY		FACILITY NUMBER:	019200509
ADMINISTRATOR:	LAGASCA-CRUZ, MARIE ANN		FACILITY TYPE:	740
ADDRESS:	33883 ALVARADO NILES RD		TELEPHONE:	(510) 489-3800
CITY:	UNION CITY	STATE: CA	ZIP CODE:	94587
CAPACITY:	110	CENSUS: 66	DATE:	04/14/2026
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Marie Ann Lagasca-Cruz, Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff failed to provide proper care and supervision to resident having suicidal ideation
Staff failed to accord privacy to resident in care

INVESTIGATION FINDINGS:

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On 4/14/26 at 10 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a 10-day initial complaint and deliver findings of the above allegations. LPA met with Executive Director, Marie Lagasca-Cruz, and explained the purpose of the visit.

Allegation: Staff failed to provide proper care and supervision to a resident having suicidal ideation- Unsubstantiated

During the investigation, the Licensing Program Analyst (LPA) conducted interviews with the Executive Director (ED), six (6) staff members, and eight (8) residents. LPA reviewed a sample of eight (8) 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, narrative charting, progress notes, and communication log.

Report Continues on LIC 9009c…

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20260409145528

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: 04/14/2026

NARRATIVE

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Report Continue LIC 9099…

It was alleged that staff failed to provide proper care and supervision to a resident having suicidal ideation. LPA reviewed a sample of eight (8) resident files and gathered various documents, including but not limited to: the staff roster with contact information, resident roster, resident admission agreements, physician reports, care plans, narrative charting, progress notes, and communication log. In addition, the LPA interviewed the Executive Director (ED), seven (7) staff members, and eight (8) residents. All seven staff members stated that if a resident expresses any suicidal ideation, they are trained to ask leading questions, help redirect the resident to understand their thoughts better, and immediately report the situation to the ED or director, who would then contact the Union City Police Department. All eight (8) residents interviewed stated that staff provides appropriate care and supervision whenever residents express—or if they were ever to express—suicidal ideation to staff or anyone else. One resident (R1) clarified, “I do not have any suicidal ideation thoughts. I called the crisis team to talk, but I never mentioned that. I am mad that people keep on asking.” R1 stated, “staff do their round check and check in with me every hour”.

Report Continue on LIC 9099c1...

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20260409145528

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: 04/14/2026

NARRATIVE

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Report continue on LIC 9099c1...

Allegation: Staff failed to accord privacy to the residents in care- unsubstantiated

During the investigation, the Licensing Program Analyst (LPA) conducted interviews with the Executive Director (ED), six (6) staff members, and eight (8) residents. The investigation focused on the allegation that staff failed to respect residents’ privacy or provide adequate privacy for them. The LPA also reviewed relevant facility documents, including staff schedules, resident records, care plans, and policy and procedure manuals regarding resident privacy. During interviews, all eight residents stated that staff consistently provide privacy during personal care activities, such as bathing, dressing, and medical treatment. Several residents mentioned that staff always knock before entering their rooms and ensure doors and curtains are closed when privacy is needed. Residents also reported that staff respect their privacy when they are talking on the phone, ensuring conversations remain private and uninterrupted. No residents interviewed reported concerns about their privacy or described any incidents in which privacy was not respected. R1 stated, “They give me privacy, staff are always there in the med room”. Both staff and residents consistently reported that privacy is maintained during care.

Based on the preponderance of evidence, the allegations are unsubstantiated. No deficiencies were cited regarding this allegation.

An exit interview is conducted, and a copy of this report is provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

LIC9099 (FAS) - (06/04)

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