331881073-2-18-2025-18-AS-JDHS-DE3PHQ-20250220102021

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881073
Report Date: 02/18/2025
Date Signed: 02/18/2025 02:28:23 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
11/02/2023 and conducted by Evaluator Kathleen Banrasavong

COMPLAINT CONTROL NUMBER: 18-AS-20231102114046

FACILITY NAME:	PACIFICA SENIOR LIVING MENIFEE		FACILITY NUMBER:	331881073
ADMINISTRATOR:	LETH, RANCE		FACILITY TYPE:	740
ADDRESS:	28333 VALLEY BOULEVARD		TELEPHONE:	(951) 679-8811
CITY:	SUN CITY	STATE: CA	ZIP CODE:	92586
CAPACITY:	220	CENSUS: 208	DATE:	02/18/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Executive Director, Rance Leth		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Residents have become ill after eating the food served at the facility
Resident has found hair inside the food and on plates

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Kathleen Banrasavong, conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA met with Administrator, Rance Leth, and explained the purpose of the visit and the elements of the allegation. The investigation included observations, interviews with staff members and residents, and a review of records.

On November 2, 2023, Community Care Licensing (CCL) received a complaint alleging that residents had become ill after eating food served at the facility and that a resident found hair inside their food and on the plates. It was alleged that three residents became ill after eating food at the facility. An interview with Administrator advised that kitchen staff follow proper protocols to ensure staff’s hair is covered during preparation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025

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-20231102114046

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 MENIFEE	FACILITY NUMBER: 331881073
	VISIT DATE: 02/18/2025

NARRATIVE

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Administrator denied that the facility had an outbreak due to incorrect handling of food prepared at the facility. Administrator indicated that they were advised of the concern of hair in food, but was unsure of the origin. An interview with Dining Director indicated that the only complaint they received was for the lack of food options and denied receiving a complaint regarding residents getting sick from the food. LPA conducted interviews with additional staff members who indicated that they were unaware of any foodborne illnesses at the facility between August 2023 and November 2023. It was also advised there were no concerns of issues and concerns regarding food preparation. Information obtained from interview with Resident 1 (R1) stated they found food on their plate and alleged it was due to staff not wearing a hairnet. It was also reported that R1 became ill after eating the food and the facility was advised of the concern. Interviews conducted with two (2) of the three (3) residents named in the complaint revealed that they became ill after eating the food served at the facility. The residents could not remember the exact dates that they became ill. Additional interviews with residents indicated that they had not experienced any issues with hair in their food and did not become sick from eating food prepared at the facility.

A review of documentation revealed that Community Care Licensing (CCL) did not receive any food borne outbreak reports during the period from August 2023 to November 2023. Also, there were no reports or documentation of residents being medically evaluated outside of the facility. During a visit conducted on 03/27/2024, kitchen staff were observed wearing the proper kitchen gear, including hairnets and uniforms. It was documented on a previous visit conducted on 11/03/2023, the LPA did observe staff to be without hairnets. LPAs did not observe any health and safety concerns.

Based on information obtained, the allegations that residents became ill after eating food served at the facility and that a resident found hair inside the food and on plates are unsubstantiated. Although the allegations may have occurred or may be valid, there is not enough evidence to prove that the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated.

An exit interview was conducted, and a copy of this report was discussed with and provided to the Administrator, Rance Leth.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025

LIC9099 (FAS) - (06/04)

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