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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881073
Report Date: 04/22/2025
Date Signed: 04/22/2025 04:35:49 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
08/18/2024 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 18-AS-20240818221750
FACILITY NAME:PACIFICA SENIOR LIVING MENIFEEFACILITY NUMBER:
331881073
ADMINISTRATOR:LETH, RANCEFACILITY TYPE:
740
ADDRESS:28333 VALLEY BOULEVARDTELEPHONE:
(951) 679-8811
CITY:SUN CITYSTATE: CAZIP CODE:
92586
CAPACITY:220CENSUS: 198DATE:
04/22/2025
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Rance Leth, Executive DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff do not meet a resident's hygiene needs
INVESTIGATION FINDINGS:
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On 4/22/25 at 8:50 a.m. Licensing Program Analyst (LPA) Melisa Rankin arrived to conduct an unannounced visit to the facility to complete the investigation and deliver the findings into the above allegation. The LPA met with Executive Director (ED), Rance Leth, and informed him of the purpose of the visit.

An initial visit on 8/21/24 by LPA Javina George was conducted. LPA George reviewed records and took copies of pertinent documentation.

On the allegation Staff do not meet a resident's hygiene needs.
Complaint alleges Resident 1’s (R1) hygiene was not good and toenails were long and unkept.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 18-AS-20240818221750
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: 04/22/2025
NARRATIVE
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Prior to arrival LPA Rankin interviewed, via phone conversations, Reporting Party (RP) on 4/18/25 and Staff 1 (S1) on 4/21/25, and reviewed interviews and documentation provided by prior LPA visit. RP stated the complaint was made to RP by the podiatrist at the hospital but had no additional information to provide LPA. During visit LPA interviewed Staff 2 (S2). Staff 2 provided R1’s admit date to the Memory Care unit which was 7/6/24. Interviews of facility staff confirmed that the caregivers do not trim residents’ nails. The facility has a podiatrist that comes every 8 weeks. A list of residents in memory care needing services is provided to the podiatrist. Interview and records reviewed for the time frame of residents admittance into memory care showed the scheduled podiatrist came 7/5/24, prior to resident admittance, and again on 9/5/24. From 8/14/24 to 11/25/24 resident was absent from the facility due to fractured hip. Record for 1/30/25 shows R1 on the list for podiatry care.

Based on interviews, and records reviewed. The allegations may have happened or is valid, but there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Copy of report printed and given to Licensee.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2