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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603451
Report Date: 11/25/2024
Date Signed: 11/25/2024 10:00:45 AM

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
04/06/2023 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230406105616
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: 113DATE:
11/25/2024
UNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Shaun McGuirk, Executive DirectorTIME COMPLETED:
10:05 AM
ALLEGATION(S):
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Illegal eviction
INVESTIGATION FINDINGS:
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On 11/25/24 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegation noted above. LPA met with Cherryrose Gajo, Resident Services Director,and Shaun McGuirk, Executive Director. where LPA explained the purpose of the visit and the elements of the allegations. The allegation was investigated and the investigation consisted of observations, interviews and records review.

On 4/6/23 Community Care Licensing received a complaint alleging an illegal eviction of Resident #1 (R1). It was alleged that a text message was sent on 04/02/23 stating that R1 needed to be moved out by the end of the week due to R1 no longer being safe or appropriate for assisted living. LPA conducted a records review of narrative charting which revealed that R1 began to exhibit a change of condition on or around 03/19/23. Further review revealed that on 03/21/23 R1s responsible party was contacted and informed that R1 “should be in a secure environment and that currently memory care was full”. On 04/02/24 after facility staff consulted with a doctor it was recommended for R1 to be seen at the emergency room for an evaluation due
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
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-20230406105616
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: 11/25/2024
NARRATIVE
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to increased behaviors of wandering and confusion, the narrative charting revealed that the recommendation was not followed. LPA conducted interviews, per the interviews conducted with the Resident Services Director, Cherryrose Gajo, the facility implemented a 1:1 Caregiver for R1 and for their safety.

Per a records review conducted, revealed that alternative placement was being looked into in or around March 2023 for R1. Per an additional records review (text message), conducted the facility suggested a resource to assist with relocating R1. R1 was unable to be interviewed as they moved out of the facility on 04/17/23. Based on interviews and records review the allegation of illegal eviction 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, LIC811-Confidential names list was provided to Cherryrose Gajo, Resident Services Director, and Shaun McGuirk, Executive Director.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2