331800055-4-19-2025-18-AS-RORN-DGUUBE-20250520152610

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800055
Report Date: 04/19/2025
Date Signed: 04/19/2025 06:21:29 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
10/02/2024 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20241002122520

FACILITY NAME:	PACIFICA SENIOR LIVING HEMET		FACILITY NUMBER:	331800055
ADMINISTRATOR:	MARK PACIA		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:	08:31 AM
MET WITH:	Brittney Walsh – Sales Director/Community Relations Representative		TIME COMPLETED:	06:35 PM

ALLEGATION(S):

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Staff do not ensure residents’ incontinence needs are met.
Staff do not respond to resident's call button.
Staff intimidated resident.
Staff spoke to resident in a disrespectful manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the above allegations. LPA met with Brittney Walsh – Sales Director/Community Relations Representative and the reason for the visit was explained, shortly after Executive Director/Administrator Barbara Bogojie arrived to assist with visit.

The investigation consisted of the following:
LPA obtained copies of staff and client rosters, toured facility, observed incontinence supplies, tested residents call buttons, and interviewed 9 residents and 4 staff.

(continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
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-20241002122520

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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The investigation revealed the following:
Allegation: Staff do not ensure residents’ incontinence needs are met.
It is alleged that S1 does not change the residents, leaving residents soiled throughout the late evening/early morning. LPA toured facility and residents rooms, sufficient supply of incontinence supplies were observed in resident rooms and caregiver station. LPA interviewed 9 residents and 8 out of 9 residents denied the above allegation, some residents stated that although it may take time for staff to arrive for assistance it may be because they are busy assisting another resident and they would have to wait their turn. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation stating that assistance is provided in a timely manner, caregivers do rounds every 2 hours (or as needed) to ensure residents needs are being met and haven’t had any complaints about this allegation. During interview with S4, it was stated that there have been no complaints or disciplinary actions against S1 for such allegation.

Allegation: Staff do not respond to resident's call button.
It is alleged that S1 does not respond to residents call buttons and was seen on their phone rather than responding to call. LPA interviewed 9 residents and 6 out of 9 staff denied the above allegation, stating that they feel staff respond within a timely manner when call buttons are pressed, some residents stated that although it may take time for staff to respond at times it is due to staff assisting other residents that are also in need of assistance. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation stating that staff does their best to provide prompt care to residents when call buttons are used, responding within 15 minutes or less depending on the situation and if staff are assisting other residents. LPA tested 2 residents call buttons and staff arrived within 7-20 minutes to provide assistance, reason for delay was that staff was busy assisting a resident with incontinence care and/or getting into bed. During interview with S4, it was stated that there have been no complaints or disciplinary actions against S1 for such allegation.

(Continued on LIC9099-C)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
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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Control Number 18-AS-20241002122520

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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Allegation: Staff intimidated resident.
It is alleged R1 asked staff to lower their voices as they were speaking loudly in the hallways at night and S1 responded by intimidating resident. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation, stating that they have never nor have they ever witnessed another staff act intimidating towards residents. LPA interviewed 9 residents and 7 out of 9 residents denied the above allegation stating that they have never felt threatened or intimidated by staff. During interview with S4, it was stated that there have been no complaints or disciplinary actions against S1 for such allegation.

Allegation: Staff spoke to resident in a disrespectful manner.
It is alleged that S1 spoke to R2 with in a disrespectful way and in a disrespectful tone. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation, stating that they have never nor have they ever witnessed another staff raise their voice or act disrespectful towards residents. LPA interviewed 9 residents and 7 out of 9 residents denied the above allegation stating that they have never felt threatened or intimidated by staff. During interview with S4, it was stated that there have been no complaints or disciplinary actions against S1 for such allegation.

Based on statements and interviews conducted with staff/residents, tour of facility and LPA observations, there was not enough supportive evidence to concur with the reported 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. Exit interview held, and a copy of this report was provided to Jocelyn Constante - MedTech.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
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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