331881073-2-19-2025-18-AS-JDHS-DE4T5Q-20250221132548

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881073
Report Date: 02/19/2025
Date Signed: 02/19/2025 03:45:32 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, 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
04/22/2022 and conducted by Evaluator Yolanda Delgado

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220422163744

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: 210	DATE:	02/19/2025
		UNANNOUNCED	TIME BEGAN:	03:37 PM
MET WITH:	Rance Leth, Executive Director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility not feeding resident in a timely manner.
Staff financially abused resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst, (LPA) Yolanda Delgado arrived unannounced to the facility to conclude an investigation pertaining to the allegations listed above. LPA met with Executive Director Rance Leth and explained the purpose of the visit.

On April 22, 2022, Community Care Licensing received a complaint alleging facility staff not feeding resident in a timely manner and staff financially abused resident. LPA conducted interviews with Administrator, staff, residents, and additional witnesses. LPA also conducted a review of pertinent documentation.

In regards to the allegation that facility is not feeding resident in a timely manner, it was reported that Resident had to wait 2 hours to eat. Information obtained from an interview with Administrator stated food trays can be ordered and would be delivered at the designated times.

(Continued on Page 2)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
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)

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Control Number 18-AS-20220422163744

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 MENIFEE	FACILITY NUMBER: 331881073
	VISIT DATE: 02/19/2025

NARRATIVE

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(Continued from Page 1)

Administrator stated the dining area is open daily from 7 am-6 pm; lunch is served from 11-1PM. Administrator stated there were no concerns advised of any resident waiting 2 hours to eat. Interview with Resident Care Director revealed that Resident had meals delivered to their room three times a day for the month of March and April 2022. It was advised that Resident started going to the dining hall to get meals. Interview with Resident stated that they do receive 3 meals a day which was Breakfast, Lunch and Dinner. Interview with an additional witness revealed that they would bring groceries to Resident and denied that facility was not feeding Resident in a timely manner.

In regard to the allegation that staff financially abused resident, it was reported that Administrator is verbally abusive and is taking money from resident. Information obtained from interviews with staff, resident and witness did not corroborate the allegation that staff financially abused resident as resident was financially responsible for themselves. Interview with Administrator denied that R1 was financially abused by any staff at the facility, denied that any staff verbally abuses any resident. Interview with witness that R1 was not verbally abused and financially abused by any staff while living at the facility. LPA conducted a review of resident’s admission agreements and assessments did not corroborate the allegation that staff financially abused resident.

Based on staff interviews, resident interviews, witnesses’ interviews, facility records, resident files, the allegations facility not feeding resident in a timely manner and staff financially abused resident is Unsubstantiated. Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted with Rance Leth and a copy of this report along with LIC811- Confidential Names list was provided.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
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)

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