331800055-4-19-2025-18-AS-RORN-DG7MQU-20250429094916

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800055
Report Date: 04/19/2025
Date Signed: 04/19/2025 06:16:55 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/23/2022 and conducted by Evaluator Christian Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220923153215

FACILITY NAME:	PACIFICA SENIOR LIVING HEMET		FACILITY NUMBER:	331800055
ADMINISTRATOR:	CRISTINA MILLER		FACILITY TYPE:	740
ADDRESS:	1177 S PALM AVE		TELEPHONE:	(951) 923-2844
CITY:	HEMET	STATE: CA	ZIP CODE:	92543
CAPACITY:	110	CENSUS: 80	DATE:	04/19/2025
		UNANNOUNCED	TIME BEGAN:	08:56 AM
MET WITH:	Executive Director Barbara Bogoje		TIME COMPLETED:	06:25 PM

ALLEGATION(S):

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Staff are not providing adequate food service to residents
Staff speak inappropriately to residents in care
Staff are not providing adequate supervision to resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Barbara Bogoje Executive Director/Administrator and explained the purpose of the visit.

The investigation consisted of the following: During the initial visit conducted on 09/26/2022, LPA Colvin interviewed one (1) staff and requested and obtained copies of documentation. During today’s visit LPA Gutierrez interviewed Executive Director/Administrator, staff #2- Staff #4, and resident #2 -resident #9. LPA toured kitchen and obtained copies of the following documents: staff roster, resident roster, food menu, R1’s admission agreement, physicians reports, and appraisal needs and service plan.

SEE LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2025

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 18-AS-20220923153215

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: PACIFICA SENIOR LIVING HEMET	FACILITY NUMBER: 331800055
	VISIT DATE: 04/19/2025

NARRATIVE

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In regard to the allegation “Staff are not providing adequate food service to residents”, it is alleged that residents are served hot dogs and non-nutritional meals. During interviews with Administrator and staff all four (4) stated residents are served nutritional food based on their diets. R4 stated they had an alternative food menu for residents. LPA toured the kitchen and observed a sufficient amount of food. During interviews with residents all stated that there were concerns about food. Residents stated there was enough and a different variety of food and that it was just not to their liking's.

In regard to the allegation” Staff speak inappropriately to residents in care”, it is alleged that staff yells and humiliates residents in care. During interviews with Administrator and staff four (4) stated that staff does not yell at residents, and they have never witnessed yelling. During interviews with residents seven (7) out of nine (9) stated that staff does does not yell at them. R9 stated that she had been yelled at before by a staff member.

In regard to the allegation” Staff are not providing adequate supervision to resident ‘it is alleged that there is not enough staff to meet the needs of residents in care causing falls. During interviews with Administrator and staff all four (4) stated that there is enough staff. S2 stated they are in the process of hiring more care givers. During interviews with residents four (4) out of nine felt that there wasn’t enough staff to meet the needs of residents. Although it may appear that not enough staff is present it was reveled during interviews that each cottage has at least one staff at all times. When assistance is needed a med-tech will provide coverage.

Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted with Med-Tech Jocelyn Constante. A copy of the report was provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2025

LIC9099 (FAS) - (06/04)

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