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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610025
Report Date: 10/23/2024
Date Signed: 10/23/2024 01:05:58 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/07/2024 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20241007122633
FACILITY NAME:PACIFICA SENIOR LIVING NORTHRIDGEFACILITY NUMBER:
197610025
ADMINISTRATOR:IVY MITCHELL SHARPFACILITY TYPE:
740
ADDRESS:8700 LINDLEY AVENUETELEPHONE:
(818) 886-5181
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:110CENSUS: 87DATE:
10/23/2024
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Ivy SharpeTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff are not safeguarding resident belongings
Staff are not providing residents with napkins at meals
INVESTIGATION FINDINGS:
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On 10/23/24, at 9:40am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Executive Director, Ivy Sharpe. LPA disclosed the purpose of the visit. LPA explained the purpose of this visit was to gather additional information, conduct staff and resident interviews and deliver findings for this complaint.

The initial investigation was conducted on 10/08/24 by LPA Gina Saucedo. On 10/23/24, LPA Saucedo asked for the census, staff, and resident rosters. On 10/23/24, LPA Saucedo interviewed staff, residents and conducted a physical tour.

9099C-continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
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 31-AS-20241007122633
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PACIFICA SENIOR LIVING NORTHRIDGE
FACILITY NUMBER: 197610025
VISIT DATE: 10/23/2024
NARRATIVE
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Regarding the allegation: Staff are not safeguarding resident belongings. It is being alleged that one (1) of the residents has been missing several clothing throughout their stay at the above facility. During LPA’s physical tour and record review, LPA was able to verify that resident #1 (R1) has a lot of clothing in their room with their name written on their clothing. Furthermore, staff revealed that R1’s belongings (clothing) have changed because R1 gained weight and their responsible party was aware of their weight change and bought new clothing for R1. Two (2) staff confirmed that in the memory care living area their name must be written on all personal belongings including their laundry bag so all their property can be safeguarded. Seven (7) out of eight (8) residents confirmed that they are not missing any personal belongings and their property has been documented previously and kept in their file. Therefore, based on the LPA's record reviews, staff and resident interviews the above allegation(s) above is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff are not providing residents with napkins at meals. It is being alleged that the facility has not provided napkins at mealtimes, and residents are having to use their clothing or just their hands. During LPA’s physical tour, LPA observed that both the memory care residents and assisted living residents do have clothed napkins during mealtimes and the memory care residents have bibs around their chest area, so their clothing does not get food stains on them. Three (3) staff confirmed that clothed napkins are provided to the residents during mealtimes for both memory care and assisted living residents. Two (2) staff did confirm that the memory care residents have a clothed napkin or bib around their chest area to prevent food from falling on their clothing. Furthermore, two (2) staff did confirm that disposable napkins are provided for special events. Seven (7) out of eight (8) residents did confirm that napkins are provided to them during mealtimes. Therefore, based on the LPA's record reviews, staff and resident interviews the above allegation(s) above is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citation(s) were issued for the above allegation(s), and a copy of this report was given to the Executive Director.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2