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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803645
Report Date: 01/09/2024
Date Signed: 01/09/2024 04:18:05 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/05/2023 and conducted by Evaluator Dominic Tobola
COMPLAINT CONTROL NUMBER: 21-AS-20231205102935
FACILITY NAME:PACIFICA SENIOR LIVING VACAVILLEFACILITY NUMBER:
486803645
ADMINISTRATOR:NOEL FACTORFACILITY TYPE:
740
ADDRESS:431 NUT TREE ROADTELEPHONE:
(707) 449-1350
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:75CENSUS: 67DATE:
01/09/2024
UNANNOUNCEDTIME BEGAN:
02:01 PM
MET WITH:Juliet McGranahan, Acting Executive DirectorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not follow infection control protocols.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 1/9/2024, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of initiating complaint investigation and was greeted by Regional Director of Operation, Julie Mason and Acting Executive Director Juliet McGranahan. LPA toured the facility, interviewed staff, reviewed facility protocol records and made observations.

Complaint alleges staff do not follow infection control protocols allowing COVID positive staff to work, as well as allowing COVID positive residents to move around facility openly. Based on a review of facility COVID protocol records, it is indicated that essential staff can return to work before 5 days of isolation with a negative test within 24 hours of returning, at least 24 hours passed since last fever or if other symptoms have improved. COVID positive staff can provide care for COVID+ residents. LPA unable to find any corroborating evidence of facility acting against the staffing COVID protocol in place.

Continued onto LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
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 21-AS-20231205102935
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: PACIFICA SENIOR LIVING VACAVILLE
FACILITY NUMBER: 486803645
VISIT DATE: 01/09/2024
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
In addition, facility COVID protocols indicate that, if an individual tests positive for COVID-19 they must isolate with transmission-based precautions and staff providing care must wear appropriate PPE. It also states that isolation can end after day 5 if:

- Symptoms are not present, or are mild and improving; AND
- Individual is fever-free for 24 hours

Interviews with lead medtech and nursing staff (S1, S2 & S3) were found to be consistent indicating that staff followed protocol to isolate COVID positive residents as well as encourage the use of masking. However, based on residents' diagnoses of Alzheimer's or Dementia as the facility is a full memory care unit, resident were often unable to follow or refused guidance or isolation techniques. S1, S2 & S3 stated that additional protocols of adjusting meal and activity times for better mitigation were implemented. Due to a lack of corroborating evidence and conflicting information, the allegation is found to be unsubstantiated.

A finding that the complaint allegation staff do not follow infection control protocols is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiency cited.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2