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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604544
Report Date: 02/20/2025
Date Signed: 02/25/2025 10:18:37 AM

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
10/14/2024 and conducted by Evaluator Alyssa Ramirez
COMPLAINT CONTROL NUMBER: 08-AS-20241014122752
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: 130DATE:
02/20/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Dining Services Director Abraham BotelloTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff are charging a resident for services not rendered
Staff did not provide resident with a complete admissions agreement
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced complaint visit to deliver findings on the above allegations. LPA met with Dining Services Director Abraham Botello and discussed the purpose of the visit and elements of the complaint.

Community Care Licensing (CCL) has investigated the above allegations. The investigation consisted of records review, interviews with facility staff and outside sources.

It was reported to CCL that staff are charging resident for services not rendered and staff did not provide resident with a complete admissions agreement.

Regarding the allegation, staff are charging a resident for services not rendered, it was reported that reporting party (RP) made arrangements for resident (R1) to move into facility in April 2024.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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 2
Control Number 08-AS-20241014122752
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: 02/20/2025
NARRATIVE
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R1 became hospitalized prior to move in date and was unable to move in. RP states that they spoke to facility staff about ensuring that room was kept available for R1 and reported that staff assured RP that there would be no additional fees until R1 moved in. In August 2024, R1 moved into facility and RP discovered that facility had been charging the resident monthly rent each month after initial move in date. Interviews with facility staff revealed that once someone signs an admission’s agreement they are taking financial responsibility for the room and rent accrues automatically in the system, while care charges begin when the resident is physically in the facility and is receiving care. Interview with facility staff revealed that no payment was made for rent owed prior to R1 moving in and facility waived all fees upon hearing about the confusion from RP. Interview with reporting party revealed that there was a misunderstanding about billing but stated that issue has been resolved. RP said that no payments were made for back owed charges and stated that facility waived all fees that were assessed prior to R1 moving in.

Regarding the allegation, staff did not provide resident with a complete admissions agreement, it was reported that after R1 moved into the facility, they were not given a current admission’s agreement that shows all the fees that will be charged. Records review revealed that a complete admissions agreement was signed and dated 4/30/24. Admissions’ agreement shows that monthly fee for R1 is $2895.00. Admissions agreement states “The Community’s Resident Services Director or his or her designee will evaluate your service needs by assessing your functional capabilities, physical status, mental condition, and social factors”. Records show that care cost was not determined at the time admissions agreement was signed and shows that care cost for R1 started on 11/1/2024. Interview’s with facility staff revealed, that RP had difficulty utilizing the facilities online portal to access all forms and facility staff reached out to assist in this via email. Records review revealed that on 9/27/25, facility staff assisted RP by email providing a username and password for online portal and informed RP that there was no billing for care costs at the time. Records review showed emails between RP, facility staff and facility accounting addressing RP concerns with billing and statements stating that late fees were waived and balance due prior to resident moving in were waived. Interview with RP revealed that they were able to get copies if admissions agreement and was ale to access to only portal. RP reported no concerns.

Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid. No deficiencies were cited today.



An exit interview was conducted with Botello. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Botello whose signature below verifies receipt of these rights.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2