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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603451
Report Date: 08/16/2023
Date Signed: 08/16/2023 01:54:42 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
08/15/2023 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230815151027
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: 109DATE:
08/16/2023
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Amy Banaga, Executive DirectorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not keep the facility free from bed bugs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to initiate an investigation into the allegation listed above. LPA met with Executive Director (ED) Amy Banaga and explained the purpose of the visit.
During today's visit, LPA interviewed five (5) staff, two (2), and reviewed and obtained copies of pertinent documents. Regarding the allegation "Staff did not keep the facility free from bed bugs", it was alleged that the facility has an ongoing issue with bed bugs. Interview with ED Banaga and Maintenance Director Roy Hayes along with records reviewed revealed the facility has been battling bed bugs for the past few years and the treatment for it is ongoing. The facility has entered a new contract with extermination company Western for K9 bed bug inspection, chemical treatment and as well as heat treatments. Interview with Daniel Slaughter, Pacifica Senior Living Regional Director of Operations revealed Western Extermination will continue with maintenance services on an ongoing basis to help mitigate the bed bug issue. The facility owns their own heat treatment machine as well which is utilized on an as needed basis. Effected resident clothes and bedding are laundered separately with the highest temperatures. Community Care Licensing has been aware of this issue. (CONTINUED ON LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023
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-20230815151027
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 ESCONDIDO
FACILITY NUMBER: 374603451
VISIT DATE: 08/16/2023
NARRATIVE
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(CONTINUED FROM LIC9099)
Although the facility has experienced bed bug issues, they are taking appropriate steps to help mitigate the problem. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2