374604604-5-13-2025-08-AS-LTEZ-DH6UEU-20250530153143

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604604
Report Date: 05/13/2025
Date Signed: 05/13/2025 01:16:50 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
05/05/2025 and conducted by Evaluator Nacole Patterson

COMPLAINT CONTROL NUMBER: 08-AS-20250505153230

FACILITY NAME:	PACIFICA SENIOR LIVING POWAY		FACILITY NUMBER:	374604604
ADMINISTRATOR:	AZEMIKHAH, CAMERON		FACILITY TYPE:	740
ADDRESS:	12750 GATEWAY PARK ROAD		TELEPHONE:	(858) 451-9933
CITY:	POWAY	STATE: CA	ZIP CODE:	92064
CAPACITY:	72	CENSUS: 46	DATE:	05/13/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Executive Director Cameron Azemikhah		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Licensee did not serve residents food of good quality.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced 10-day visit to initiate a complaint investigation and deliver findings regarding the above-mentioned allegation. LPA identified themselves and met with Executive Director Cameron Azemikhah, to discuss the purpose of the visit and elements of the complaint.

On 05/05/2025 it was alleged that Licensee did not serve residents food of good quality. The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, residents, outside sources, and records review. Staff interviews revealed observations of various wait times, which were not observed to all be consistently long. Staff informed that two serving staff were out at the same time recently which resulted in staffing adjustments; while this affected wait times slightly, the times were not reported to be in excess of 15 minutes from when the resident ordered their food. Staff offered that possibly during high service times, plates of the daily special were prepared prior to being ordered which could have cooled down the temperature, however staff would immediately re-heat the food if a resident informed it was not warm enough for their preference. (Continued on LIC9099-C).

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Nacole Patterson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

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-20250505153230

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 POWAY	FACILITY NUMBER: 374604604
	VISIT DATE: 05/13/2025

NARRATIVE

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(Continued from LIC9099 p.1)

Staff interviews additionally revealed that the chef meets with residents each month to discuss food service, and the facility adjusts as much as reasonably possible to accommodate all requests. Staff informed that transport time could affect the temperature of room service trays, however all residents are supplied with a personal microwaves in their rooms to reheat food to their preference.

Resident interviews were consistent regarding the quality of food and options served at the facility, but interviews varied regarding serving times. Residents consistently stated that the food was good or great, and that they had options to choose from. Some residents experienced no wait for their meals and some residents felt that they did have to long periods for their food to arrive once ordered. All residents emphatically informed that staff would re-heat their food promptly if asked. It should be noted that interviews revealed that the dining room doors were open at all times, and some residents came into the dining room up to 60-90 minutes prior to the scheduled meal time, skewing their perception of wait times.

Records review showed that all kitchen staff had food handler's cards, and training titled, "Food and Kitchen Safety". Weekly facility menus showed a variety of food options, with a different special offered each day for each meal. The menus included a section titled, "Alternate Menu", with 13 options that could be ordered outside of the special main dish. Additional records included photos, with timestamps and location, of recent meals served at the facility.

During an unannounced facility visit LPA directly observed the food service at the facility; all food was observed to be of good quality with no issues observed regarding food handling requirements or safety. LPA observed warming buffets with active steam as well as a hot box with warming trays set to 135 degrees.

While the investigation revealed that sporadic issues regarding food temperatures and wait times had occurred, the instances were not shown to be consistent or common. Further, the investigation showed that the facility immediately corrected issues made known to them with increased training, staff support, or changes in procedure.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Executive Director Cameron Azemikhah, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Nacole Patterson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

LIC9099 (FAS) - (06/04)

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