331881073-2-21-2025-18-AS-TDAN-DE7VJB-20250224152829

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881073
Report Date: 02/21/2025
Date Signed: 02/21/2025 03:36:20 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
01/25/2024 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240125113223

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: 174	DATE:	02/21/2025
		UNANNOUNCED	TIME BEGAN:	02:12 PM
MET WITH:	Rance Leth, Executive Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility has mold.
Facility roof is in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA Javina George made an unannounced visit to the facility to commence a complaint investigation in regard to the allegations noted above. LPA met with Executive Director Rance Leth and explained the purpose of the visit and the elements of the allegations. The allegations were investigated, which consisted of observations, interviews and records review.

On January 25, 2024, Community Care Licensing received a complaint alleging that the facility has mold and that the facility roof is in disrepair. Regarding the allegation of the facility has mold specifically in Resident #1 (R1)s and Resident #2 (R2)s bedroom. On 01/31/24 LPA conducted a tour of the interior and exterior areas of the property. LPA did not observe the presence of mold, or a mold like odor. In addition LPA conducted interviews with facility staff whom denied there being any reports from other staff, visitors or residents reporting that they have physically seen or smelled mold at the facility. In addition per an interview with Maintenance Director Ryan Kolster there was no testing conducted to confirm that there was mold in R1s and R2s bedroom. Per an interview with R1 and R2 the allegation could not be corroborated as R1 and R2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

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-20240125113223

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: 02/21/2025

NARRATIVE

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denied seeing mold inside their bedroom, and confirmed that there was no testing done in their bedroom for mold. Based on observations, interviews and records review the allegation of facility has mold is unsubstantiated.

Facility roof is in disrepair

It was alleged that on or around 01/25/24 there was a leak inside the roof in R1 and R2s bedroom. On 01/31/24 LPA conducted the initial 10 day visit to the facility and observed for right corner of the ceiling in the second bedroom in R1 and R2s unit to have been patched with a white temporary replacement tile/cover. Per interviews conducted with R1 and R2 there was a leak and it is in the process of being repaired. Per an interview with Maintenance Director Ryan Kolster the was a leak in the roof in the unit, that was discovered in December 2023, an HVAC Specialist came out and was able to drain the pipe.

LPA conducted a records review (email) that revealed the Executive Director Rance Leth was aware of a leak, and had requested assistance with getting the leak remedied from corporate as, the issue was reoccurring. The leak was repaired on 1/22/24 as the drain was sealed the drain from the roof and a drip pan installed. Per an interview with Resident Services Director Rachelle Wheaton both R1 and R2 were offered to move to another unit but declined. Per an interview with R1 they did confirm that they declined to be moved as they like the view from their current unit. R2 reported it was the dripping sound that was the most bothersome. Based on observations, interviews and records review the allegation of facility roof is in disrepair is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted and a copy of this report and LIC 811-confidential names list was reviewed and provided to Executive Director Rance Leth.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC9099 (FAS) - (06/04)

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