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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604544
Report Date: 03/09/2023
Date Signed: 03/09/2023 04:40:24 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/02/2023 and conducted by Evaluator Liliana Silveira
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20230302094940
FACILITY NAME:PACIFICA SENIOR LIVING BONITAFACILITY NUMBER:
374604544
ADMINISTRATOR:MARKOVICH, PAULFACILITY TYPE:
740
ADDRESS:3434 BONITA ROADTELEPHONE:
(619) 476-9444
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:145CENSUS: 97DATE:
03/09/2023
UNANNOUNCEDTIME BEGAN:
04:10 PM
MET WITH:Business Office Manager Rebecca TovesTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Licensee did not issue a refund to responsible party.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced visit to open a complaint investigation regarding the above mentioned allegation. LPA identified themselves, stated the purpose of the visit and was granted entry by Business Office Manager Rebecca Toves. LPA explained the purpose of the visit and the elements of the complaint.

The Department’s investigation consisted of interviews and a records review. On March 2, 2023, it was alleged that the Licensee did not issue a refund to a responsible party after the death of a resident. A records review, as well as interviews with staff and outside sources, revealed that Resident 1’s (R1- see LIC 809 Confidential Names List) belongings were removed from the facility by December 24, 2022. R1’s Responsible Party (RP) was due a refund of basic services paid for December 25, 2022 to December 31, 2022, in the pro-rated amount of $1,642.71. R1’s RP was also due a refund for basic services charged in advance for the month of January 2023 in the amount of $6,000. The total refund amount due to the RP was $7,642.71. (CONTINUED ON LIC 9099 9099-C)

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023
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 08-AS-20230302094940
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: PACIFICA SENIOR LIVING BONITA
FACILITY NUMBER: 374604544
VISIT DATE: 03/09/2023
NARRATIVE
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A records review, as well as interviews with Rebecca Toves and outside sources, revealed that a refund of $7,642.71 was mailed to the RP on March 2, 2023. Interviews with outside sources also revealed that the RP received the refund on March 6, 2023.

Due to lack of corroborating evidence, the findings regarding the above allegation were established to be unsubstantiated. This finding means that although the allegation may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

LPA Silveira conducted an exit interview with Rebecca. At the time of the exit interview Rebecca was provided with a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016) and signature on this report acknowledges receipt of the rights.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2