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Inspection visit

Health check

PACIFICA SENIOR LIVING UNION CITYLicense 0192005092 citations on this visit
2 citations recorded

Inspector’s narrative

What the inspector wrote

On this day, November 28, 2023, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a health and safety inspection as a result of the Department receiving a priority 1 complaint (Complaint # 15-AS-20231122143232). LPA met with Executive Director (ED) Robert 'Rob' Roby and Assisted Living Director Shenina Robinson-Mason. LPA toured the facility including but not limited to common areas, dining rooms, medication room, activity rooms/areas, and bathrooms on the first and second floors. LPA observed the medication room open and attended by a med-tech. LPA randomly selected for inspection a total of 5 resident rooms on the first and second floors. During review of 4 residents records, LPA observed no Death Report and Unusual Incident Report (UIR) for 1 of the residents. Deficiencies are cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalties. Deficiencies were discussed with ED. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.

Citations

3 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 87211(a)(1)(A)Type B

    87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency....(1) A written report shall be submitted to the licensing agency ... within seven days of the occurrence of any of the events......(A) Death of any resident from any cause regardless of where death occured -This requirement is not met evidenced by:-Based on record review, the licensee did not comply with the section above for not submitting the death report within 7 days which posed potential personal rights risk to person in care.

  • 87211(a)(1)(D)Type B

    87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency....(1) A written report shall be submitted to the licensing agency ... within seven days of the occurrence of any of the events.....(D) Any incident which threatens the welfare, safety or ........ ......health of any resident......-This requirement is not met evidenced by:-Based on record review, the licensee did not comply with the section above for not submitting an incident report within 7 days which posed potential personal rights risk to person in care.

  • 87506(a)Type B

    87506 Resident Records(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. -This requirement is not met as evidenced by:-Based on records review and interviews, the licensee did not comply with the section above for not having records in the emergency binder for 3 out of 4 residents which pose potential health and personal rights risks to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the November 28, 2023 inspection of PACIFICA SENIOR LIVING UNION CITY?

This was a other inspection of PACIFICA SENIOR LIVING UNION CITY on November 28, 2023. 2 citations were issued: 2 Type B.

Were any citations issued to PACIFICA SENIOR LIVING UNION CITY on November 28, 2023?

Yes, 2 citations were issued (0 Type A, 2 Type B). The first citation was for: "87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency....(1) A written report shall be sub..."

What type of inspection was this?

This was a other inspection. other inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLDView original report

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.