<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005272
Report Date: 02/19/2025
Date Signed: 02/19/2025 03:17:00 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/08/2022 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220308092622
FACILITY NAME:PACIFICA SENIOR LIVING SOUTH COASTFACILITY NUMBER:
306005272
ADMINISTRATOR:STACIE ANDERSONFACILITY TYPE:
740
ADDRESS:2619 ORANGE AVETELEPHONE:
(949) 515-0121
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY:98CENSUS: 36DATE:
02/19/2025
UNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Yaylene MazariegosTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility did not safeguard resident's cellphone which led to its theft.
Facility did not follow their theft and loss policy regarding the theft of resident's cellphone
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegations. LPA met with Administrator (AD) Yaylene Mazariegos, discussed the purpose of the inspection, and explained the allegations.

The investigation into the allegations that facility did not safeguard resident's cellphone which led to its theft and the facility did not follow their theft and loss policy regarding the theft of resident's cellphone revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, staff, and residents, and obtained and reviewed copies of the resident roster, staff roster, and Resident #1’s (R1) Admission Agreement.

CONTINUED
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
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 3
Control Number 22-AS-20220308092622
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: PACIFICA SENIOR LIVING SOUTH COAST
FACILITY NUMBER: 306005272
VISIT DATE: 02/19/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding the allegation that facility did not safeguard resident's cellphone which led to its theft: it was alleged that R1’s cell phone went missing from their room, staff searched for the phone and could not find it, the phone reappeared in R1’s room a few days after it went missing without explanation, and one of R1’s hearing aids also went missing. LPA inspected the facility, conducted health and safety checks on residents present, and observed no health and safety issues. LPA interviewed AD who stated that R1 is no longer a resident of the facility, there are no major issues regarding theft and loss at the facility, the facility does not handle or store resident property, and residents are responsible for safeguarding the property they bring into the facility. LPA interviewed Staff #1 (S1), the staff who oversaw the investigation into R1’s missing property, who denied the allegation. S1 denied there are major issues regarding theft or loss at the facility, stating that most lost items were later found. S1 stated they investigated the loss of R1’s cell phone and hearing aid and did not obtain information that they were stolen. LPA interviewed six residents and obtained information that there was at least one other alleged theft approximately two years ago that was investigated by the police, but the police could not identify the suspect and LPA did not obtain information that there are systemic issues of theft at the facility. LPA interviewed two out of two care staff present and did not obtain information corroborating the allegation. The information obtained did not corroborate that R1’s missing items were stolen, that there is a systemic issue of theft at the facility, or that the facility’s theft and loss policies are inadequate. The information obtained did not corroborate the allegation.

Regarding the allegation that the facility did not follow their theft and loss policy regarding the theft of resident's cellphone: it was alleged that R1’s cell phone and hearing aid went missing, the facility was aware of another resident who sometimes takes other residents’ property but did not search this resident’s room for the missing items, and the facility did not investigate the thefts, review camera footage, or call the police. LPA inspected the facility, conducted health and safety checks on residents present, and observed no health and safety issues. LPA reviewed R1’s Admission Agreement which indicates that the facility’s theft and loss policy states that the facility will create an inventory of each resident’s personal items brought into the facility and the facility will not be responsible for items not on that inventory. Per R1’s Admission Agreement, R1’s personal property inventory, which R1 signed, did not include R1’s cell phone or hearing aid. LPA interviewed AD who stated that there are no major issues regarding theft and loss at the facility, the facility does not handle or store resident property, and residents are responsible for safeguarding the property they bring into the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20220308092622
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: PACIFICA SENIOR LIVING SOUTH COAST
FACILITY NUMBER: 306005272
VISIT DATE: 02/19/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA interviewed S1, the staff who oversaw the investigation into R1’s missing property, who denied the allegation. Per S1, the facility’s theft and loss policy is that the facility is not responsible for missing items unless the loss was caused by the facility, but that the facility will investigate lost property, determine what happened, and punish those responsible and that the facility followed this policy with regards to R1’s missing items. S1 stated that when R1’s phone went missing, R1’s room was searched, multiple staff were interviewed, R1’s family was contacted, the transport company that R1 used was also contacted, and staff found the phone a few days after it was missing and returned it to R1. Regarding the missing hearing aid, S1 stated they interviewed staff and could not locate the hearing aid. Regarding the other resident who sometimes takes other residents’ property, S1 confirmed that this resident has a history of taking other residents’ property, but stated that this resident’s room was searched for both the cell phone and hearing aid and neither item was found in their room. S1 also stated they reviewed camera footage which did not reveal information helpful to the investigation. While the facility’s theft and loss policy states stolen items must be reported to law enforcement, the facility’s investigation did not determine that R1’s hearing aid was stolen. The information obtained did not corroborate that the facility did not properly investigate R1’s missing items or otherwise not follow its theft and loss policy. The information obtained did not corroborate the allegation.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3