<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604544
Report Date: 02/13/2025
Date Signed: 02/13/2025 01:46:36 PM

Substantiated


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
10/22/2024 and conducted by Evaluator Iby Strong
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20241022165133
FACILITY NAME:PACIFICA SENIOR LIVING BONITAFACILITY NUMBER:
374604544
ADMINISTRATOR:REBECCA TOVESFACILITY TYPE:
740
ADDRESS:3434 BONITA ROADTELEPHONE:
(619) 476-9444
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:145CENSUS: 128DATE:
02/13/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Executive Director Rebecca TovesTIME COMPLETED:
01:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident call pendant was not in working condition
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Iby Strong conducted an unannounced complaint visit to deliver findings in the above-mentioned allegation. LPA met with Executive Director Rebecca Toves and discussed the purpose of the visit.

On October 22, 2024, Community Care Licensing (CCL) received a complaint alleging resident call pendant was not in working condition. During investigation, LPA Strong collected pertinent resident records, made observations, and conducted interviews.

According to the allegation, on October 19, 2024, Resident 1 (R1) pressed their call pendant and waited for over three hours for assistance in toileting, when it was reported to staff it was found that pendant was not sending signal to staff. On October 30, 2024, LPA Strong conducted a facility inspection and observed multiple residents pressing their pendants. On this date, LPA Strong observed and video recorded two of five resident pendants malfunctioning as the residents were unable to activate the pendant upon pressing it. LPA showed Executive Director the recording of the malfunctioning pendants.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
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 5
Control Number 08-AS-20241022165133
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 BONITA
FACILITY NUMBER: 374604544
VISIT DATE: 02/13/2025
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
Based on observations and interviews, a preponderance of evidence exists to support the allegations. Deficiencies are being cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted with Executive Director Rebecca Toves, to whom a copy of this report, LIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
10/22/2024 and conducted by Evaluator Iby Strong
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20241022165133

FACILITY NAME:PACIFICA SENIOR LIVING BONITAFACILITY NUMBER:
374604544
ADMINISTRATOR:REBECCA TOVESFACILITY TYPE:
740
ADDRESS:3434 BONITA ROADTELEPHONE:
(619) 476-9444
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:145CENSUS: 128DATE:
02/13/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Executive Director Rebecca TovesTIME COMPLETED:
01:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility telephone was not in working condition
Licensee was not providing complete housekeeping
Licensee was not providing assistance with bathing
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to deliver findings in the above-mentioned complaint allegations. LPA identified herself and discussed the purpose of the visit with Executive Director Rebecca Toves.

On October 22, 2024, Community Care Licensing (CCL) received a complaint alleging facility telephone was not in working condition, there was no complete housekeeping provided to residents and licensee was not providing resident assistance with bathing. During investigation, LPA Strong collected pertinent facility records, made observations, and conducted interviews.

According to the first allegation, on October 19, 2024, Resident 1 (R1) attempted to call the front desk via telephone and telephone service to the facility was not functioning. Interview with Administrator revealed that the telephone service was not functioning, and emergency technicians were contacted to assist in getting service fixed within the same day.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20241022165133
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 BONITA
FACILITY NUMBER: 374604544
VISIT DATE: 02/13/2025
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
LPA Strong reviewed an invoice for the weekend of October 19, 2024, dated October 21, 2024, with charges for parts, labor, and emergency visit. LPA Strong called the facility phone number on October 22, 2024, and October 30, 2024, and the telephone was answered promptly by receptionist.

It was also alleged that housekeeping staff assigned to R1’s room were not providing complete room cleaning from regular bathroom maintenance to vacuuming. Interview with staff assigned to R1’s room revealed that they provided extra cleaning care and attention to R1 as R1 had requested more assistance. Records reviewed shows facility room cleaning checklist which includes floor care and general cleaning of bathrooms. Interview with an outside source revealed that staff provide regular room care as noted in residents’ rooms. LPA observed R1’s room on October 30, 2024, which was clean and organized.

Lastly it was alleged R1 did not receive assistance with bathing. Records collected revealed staff notes that showed R1 has verbally declined regular scheduled bathing and requested it to be pushed out. Interview with R1 did not reveal any information to corroborate that R1 did not receive bathing assistance. Interview with other resident did not reveal any information to corroborate that residents are not receiving assistance with bathing. Interview with outside source did not reveal other residents do not receive assistance with their scheduled bathing.

Based on multiple interviews and record reviews, there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Executive Director Rebecca Toves to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20241022165133
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 BONITA
FACILITY NUMBER: 374604544
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2025
Section Cited
CCR
87303(i)(1)(B)
1
2
3
4
5
6
7
 shall have signal systems which shall meet the following criteria: 1) All facilities licensed for 16 or more a....shall have a signal system which shall: (B)Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff.
1
2
3
4
5
6
7
Licensee has already begun daily pendant checks and alarm clearing, Maintanance team has also initiated monthly random checks of pendants to verify working conditions. Adminsitrator stated they are updating the system and getting outside company quotes. Adminsitrator will provide a written letter to LPA to confirm such continous checks.
8
9
10
11
12
13
14
This requirement was not met in evidence as: Based on interviews and observations the licensee did not provide a working pendant for 2 of 120 persons in care which posed a potential Health, Safety, or Personal Rights risk to persons in care
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5