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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603451
Report Date: 03/22/2023
Date Signed: 03/22/2023 09:29:37 AM

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
03/09/2023 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230309111059
FACILITY NAME:PACIFICA SENIOR LIVING ESCONDIDOFACILITY NUMBER:
374603451
ADMINISTRATOR:AMY BANAGAFACILITY TYPE:
740
ADDRESS:1351 E WASHINGTON AVETELEPHONE:
(760) 741-3055
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY:143CENSUS: 108DATE:
03/22/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jessica Playa, Business Office ManagerTIME COMPLETED:
09:35 AM
ALLEGATION(S):
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Staff does not ensure bed bug issue is being properly addressed
Facility does not ensure food of good quality is served to residents in care
Facility does not ensure that snacks are made available to residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conclude an investigation into the allegations listed above. LPA met with Business Office Manager Jessica Playa and explained the purpose of the visit. Executive Director Amy Banaga was not available.
Regarding the allegation "Staff does not ensure bed bug issue is being properly addressed", it was alleged that the facility is infested with bed bugs. Interview with ED Banaga and records reviewed revealed the facility has an ongoing fight with bed bugs over the past few years. The facility maintains a contract with Orkin extermination company for a K9 bed bug inspection which is done quarterly. The facility has purchased it's own bed bug heat treatment machine which is then utilized to apply treatments to those areas identified by the bed bug K9. Community Care Licensing has been aware of this issue. Although the facility has experienced bed bug issues, they are taking appropriate steps to help mitigate the problem.
Regarding the allegation "Facility does not ensure food of good quality is served to residents in care", it was alleged that the food served at the facility is of poor quality, menu choices have been cut down to one, food is processed and not fresh, scrambled eggs come out of a box, bacon is always burnt, soups and meat are greasy, vegetables and fruit are frozen or canned, and the fruit is canned fruit cocktail. (CONTINUED ON LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
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-20230309111059
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 ESCONDIDO
FACILITY NUMBER: 374603451
VISIT DATE: 03/22/2023
NARRATIVE
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(CONTINUED FROM LIC9099)
Interviews were conducted with ten (10) residents and LPA toured the kitchen and inspected the facility's food supply. During LPA's tour of the kitchen, a multitude of fresh vegetables and fruits such as onions, lettuce, carrots, potatoes, mushrooms, zucchini, cabbage, apples, bananas, oranges, lemons, and limes were observed in the refrigerator as well as in the actual food prep area being prepared for residents. Meats such as chicken, pork, hamburger, and brisket were also observed in the refrigerator and freezer. Cartons of liquid scrambled eggs were observed in the refrigerator as well. LPA observed lunch service of soup, roasted turkey, yams, green beans, and a dessert of pumpkin cake which was in accordance with the planned menu. Interviews were conducted with ten (10) residents. Nine (9) of ten (10) residents interviewed reported the food served at the facility is of good quality. All ten (10) residents interviewed reported there are choices or alternatives available. Nine (9) of ten (10) residents interviewed reported the meat served at the facility was not greasy. All ten (10) residents interviewed reported the soup served was not greasy. All ten (10) residents interviewed reported the bacon served is cooked to a very crispy state and six (6) of ten (10) residents reported they prefer it that way.
Regarding the allegation "Facility does not ensure that snacks are made available to residents in care", it was alleged that the facility does not provide snacks in between meals. All ten (10) residents interviewed revealed snacks are available in the dining room upon request. During facility tour, LPA observed snacks such as cake and fruit from the dining room in several resident rooms.
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, therefore the allegations are unsubstantiated. An exit interview was conducted and copy of this report was provided.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2