374604300-3-9-2026-08-AS-SMAZ-DSQNF7-20260401102505

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604300
Report Date: 03/09/2026
Date Signed: 03/09/2026 03:50:21 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
05/11/2023 and conducted by Evaluator Rebecca A Borunda

COMPLAINT CONTROL NUMBER: 08-AS-20230511105627

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: 92	DATE:	03/09/2026
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Business Office Manager Virginia Rodriguez		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff handled resident roughly, resulting in bruising
Staff did not treat residents with dignity

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced complaint visit to conduct follow up and deliver findings regarding the above-mentioned allegations. LPA identified herself to, was greeted by, and explained the purpose of the visit to Business Office Manager Virginia Rodriguez.

During today’s visit, LPA observed residents in care, obtained copies of facility records, and interviewed staff.

The Department’s investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that staff handled Resident 1 (R1) roughly, resulting in bruising and staff did not treat resident with dignity. Review of R1’s medical and care assessment records dated 2021 revealed that R1 did not have any cognitive impairment and required assistance with bathing, dressing, grooming, and toileting.

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: 03/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2026

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 08-AS-20230511105627

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: 03/09/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

However, review of progress notes in 2022 and 2023 revealed that beginning in October 2022, R1 began experiencing visual hallucinations and was noted to be confused and disoriented. Outside source interviews provided supporting evidence that that R1 occasionally had hallucinations and had issues with short-term memory. R1 stated during interviews that they felt some staff were pleasant, however staff personalities determined if R1 felt comfortable with their care. Unfortunately, R1 did not provide clarifying details regarding the care provided by staff. Additionally, R1 did not provide any information or details to support the allegation that R1 sustained injuries from staff care. Outside sources were also unable to provide information regarding R1 sustaining any injuries, including one outside source who stated that they had not observed any bruising on R1. Interviews with other residents did not reveal concerns regarding the care provided by the staff at the facility. Interviews with staff did not reveal any evidence that R1 had any unexplained bruising or other marks and denied knowledge of any complaints regarding staff behaviors.

The Department has investigated the above-mentioned allegations and based on interviews and records review, 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 03/22).

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2