374604300-10-30-2025-08-AS-SMAZ-DN5P49-20251105095843

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604300
Report Date: 10/30/2025
Date Signed: 10/30/2025 03:24:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/24/2025 and conducted by Evaluator Rebecca A Borunda

COMPLAINT CONTROL NUMBER: 08-AS-20250124110344

FACILITY NAME:	PACIFICA SENIOR LIVING OCEANSIDE		FACILITY NUMBER:	374604300
ADMINISTRATOR:	BANKS, JAQUELINE		FACILITY TYPE:	740
ADDRESS:	5508 AVENIDA PACIFICA WAY		TELEPHONE:	(760) 978-6602
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92057
CAPACITY:	165	CENSUS: 98	DATE:	10/30/2025
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Executive Director Kristel Johnson		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Licensee financially abused a resident
Staff did not treat resident with dignity

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Executive Director Kristel Johnson.

The Department’s investigation consisted of interviews with residents, staff, and outside sources, review of facility records, and a tour of the facility. It was alleged that the Licensee financially abused a resident and staff did not treat resident with dignity. Interviews with multiple residents did not reveal issues or concerns with staff interactions and residents denied that staff interactions made residents feel rushed, disrespected, or that staff were rude. Residents stated that staff were polite and nice. However, interviews with Resident 1 (R1) expressed feelings of disrespect when interacting with staff. Interviews with residents and staff revealed that R1 had a tendency to video record interactions that R1 had with other residents and staff, resulting in those residents and staff feeling uncomfortable.
Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025

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 08-AS-20250124110344

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PACIFICA SENIOR LIVING OCEANSIDE	FACILITY NUMBER: 374604300
	VISIT DATE: 10/30/2025

NARRATIVE

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LPA observations during multiple on-site visits between January and May 2025 did not reveal any instances of staff interacting with residents, including R1, in an inappropriate, disrespectful, or rude manner. Interviews with R1, residents, staff, and LPA observations revealed that R1 could be difficult to interact with due to R1’s personality. During interviews, staff and residents expressed a desire to avoid interactions with R1 due to R1’s video recording behaviors and personality. Interviews and records review revealed that R1 was evicted from the facility in early October 2025 due to violating house rules regarding treating residents and staff with respect.

Review of R1’s financial statements from November 2024 to October 2025 revealed that R1 had monthly reoccurring charges for basic room and board and R1 did not receive any care, resulting in R1 not being charged for any care. Review of R1’s admission agreement revealed that the facility would charge a late fee of $250 for any payments received after the fifth day of the month. Despite R1 submitting payment for basic room and board after the 5th of the month on multiple occasions, R1 was not charged a late fee. Additionally, multiple interviews with R1 did not disclose any concerns that R1 was charged for services that R1 did not receive or were not previously explained.

The Department has investigated the above-mentioned allegations and based on interviews, record review, and observation, the preponderance of the evidence has not been met, therefore, these allegations are deemed unsubstantiated.

An exit interview was conducted with Executive Director Kristel Johnson, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025

LIC9099 (FAS) - (06/04)

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