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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881073
Report Date: 12/11/2024
Date Signed: 12/11/2024 04:04:53 PM

Document Has Been Signed on 12/11/2024 04:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:PACIFICA SENIOR LIVING MENIFEEFACILITY NUMBER:
331881073
ADMINISTRATOR/
DIRECTOR:
LETH, RANCEFACILITY TYPE:
740
ADDRESS:28333 VALLEY BOULEVARDTELEPHONE:
(951) 679-8811
CITY:SUN CITYSTATE: CAZIP CODE:
92586
CAPACITY: 220CENSUS: 176DATE:
12/11/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Rance Leth, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Yolanda Delgado made an unannounced visit to the facility to conduct a Case Management visit pertaining to a self-report made to RO on 11/25/2024 for theft of money from a resident and 12/3/2024 for theft of a ring for a resident. LPA Delgado met with Administrator Rance Leth to explain the reason for the visit, Administrator stated that Law enforcement was called and police reports were filed. Administrator stated that a search was conducted for Resident #1 (R1)'s missing money and a partial of it was recovered and the ring was recovered by the Resident #2 (R2)'s relative. LPA interviewed Administrator and one (1) staff.

During the visit, LPA toured the facility, observed sufficient staff, did not find no immediate health and safety concern.

There are no deficiencies being cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted and a copy of this report was reviewed with and provided to Facility representative.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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