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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209116
Report Date: 08/09/2024
Date Signed: 08/09/2024 01:03:09 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/07/2024 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20240807101955
FACILITY NAME:PACIFICA SENIOR LIVING FRESNOFACILITY NUMBER:
107209116
ADMINISTRATOR:MONTELONGO, BRANDONFACILITY TYPE:
740
ADDRESS:1715 E ALLUVIAL AVENUETELEPHONE:
(559) 298-4900
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:100CENSUS: 100DATE:
08/09/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator, Brandon MontelangoTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not keeping facility free of pests.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/09/2024 Licensing Program Analysts (LPA's) Sarah Hurt and Martin Vega arrived at the facility unannounced to conduct an investigation regarding the allegation listed above. LPA met with Administrator Brandon Montelango, and explained the purpose of todays visit.

Regarding the allegation Staff not keeping facility free of pests.LPA's interviewed Resident 1 who stated the facility has already taken care of the pest issue. Resident 1 stated the pest issue was treated within one week of staff being informed. Facility staff was notified of pest issue on 07/31/2024, and Administrator provided invoice for pest treatment dated 08/08/2024. Resident 1's bedroom did have a pest issue, and the facility handled in a timely manner. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
No deficiencies cited today, Per Title 22 Regulations.
Exit interview conducted with facility Administrator Brandon Montelango, and a copy of this report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024
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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