Inspection visit

complaintApril 25, 2024

Clean visit · 0 citations

Inspector’s narrative

What the inspector wrote

[CONTINUED FROM LIC 9099] CCLD reviewed a copy of this letter, which cited the reason for eviction was that R1 now required a “higher level of care” beyond what the facility could provide. According to the 07/19/2022 care conference meeting agenda, and corroborated by interviews of both parties, one of the cited changes in condition for R1 since move-in was that they had increased “stiffness” in their body and that they had lost the ability to help staff during transfers and repositioning in, and to/from, bed. R1 had also become increasingly frightened during said transfers. According to R1’s LIC602A Physician’s Report (dated 07/30/2021), their doctor determined that R1’s was of “non-ambulatory” status, as of that date. (According to the LIC602A’s printed instructions for the doctor, which conform to regulatory definitions, residents who cannot turn or reposition themselves in bed must be deemed “Bedridden” instead of “Non-Ambulatory.”) The LIC603 Pre-Placement Appraisal, which Licensee authored on 08/04/2021, corroborated that R1 was “Non-Ambulatory” status, as of that date. Interviews of facility caregivers aligned to show: When R1 first moved-in to the facility, R1 was wheelchair-dependent and on hospice are, but their body was still strong enough that they could bear some of their own body weight during transfers. R1 at time of move-in required assistance of one caregiver for transfers, without needing a mechanical lift. They were also able to turn and reposition themselves in bed. Over time, R1 graduated to requiring a Hoyer-lift machine with a sling, plus assistance of two caregivers, for transfers. By the time of the 07/01/2022 care conference, R1 was no longer able to turn and reposition themselves in bed. Hospice agency electronic date and time-stamped progress notes showed: During the three months leading up to 07/19/2022, multiple hospice staff documented that R1 was becoming harder to transfer due to increasing stiffness in their body. Per R1’s hospice care plan, the Hoyer lift machine was added to the plan on an as-needed basis starting 01/12/2022. The Department determined that the basis for R1’s eviction was valid. [CCLD found that the contents of Licensee’s eviction letter did not meet all regulatory requirements – these deficiencies were addressed on a separate Case Management visit report.] Based on interviews and records, a preponderance of evidence does not exist to prove that Licensee pursued a resident eviction for an invalid reason. The allegation is therefore Unsubstantiated. An exit interview was conducted with Riosa, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

Citations

4 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.

87468.2(a)(3)Type B
87468.2 Additional Personal Rights of Residents in Privately Operated Facilities: “(a)…residents…shall have all of the following personal rights: (3)…Residents shall be free from interference, coercion, discrimination, and retaliation in exercising their rights.” This requirement was not met, as evidenced by: Based on records and interview, Licensee did not ensure that 2 of 6 residents (R1 and R2) were free from interference and retaliation in exercising their rights. This posed a potential personal rights risk to persons in care.
87224(d)(1)(C)Type B
87224 Eviction Procedures: “(d)(1) The notice to quit shall include the following information: (C) A statement informing residents of their right to file a complaint with the licensing agency, as specified in Section 87468, subsection (a)(4), including the name, address and telephone number of the licensing office with whom the licensee normally conducts business, and the State Long Term Care Ombudsman office.” Based on records and interview, for 1 of 6 residents (R1), Licensee did not ensure that their notice to quit included a statement informing them of their right to file a complaint with the licensing agency, including the name address and telephone number of the local licensing office and the State Long Term Care Ombudsman office. This posed a potential personal rights risk to persons in care.
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87224(d)(1)(D)Type B
87224 Eviction Procedures: “(d)(1) The notice to quit shall include the following information: (D) The following exact statement as specified in Health and Safety Code Section 1569.683(a)(4): "In order to evict a resident who remains in the facility after the effective date of the eviction, the residential care facility for the elderly must file an unlawful detainer action in superior court and receive a written judgment signed by a judge. If the facility pursues the unlawful detainer action, you must be served with a summons and complaint. You have the right to contest the eviction in writing and through a hearing." Based on records and interview, for 1 of 6 residents (R1), Licensee did not ensure that their notice to quit included the exact statement that is specified in California Health and Safety Code Section 1569.683(a)(4). This posed a potential personal rights risk to persons in care.
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87465(h)(4)Type B
87465 Incidental Medical and Dental Care: “(h)(4) All centrally stored medications shall be…maintained in compliance with state and federal laws.” This requirement was not met, as evidenced by: Based on interview and LPA observation, Licensee did not ensure that all centrally stored medications were maintained in compliance with state and/or federal laws. This posed a potential health and safety risk to 2 of 6 residents (R1 and R2) in care.

FAQ · About this visit

Common questions about this visit

What happened during the April 25, 2024 inspection of SOUTH PACIFIC VILLA?

This was a complaint inspection of SOUTH PACIFIC VILLA on April 25, 2024. The inspection found no deficiencies and no citations were issued.

Were any citations issued to SOUTH PACIFIC VILLA on April 25, 2024?

No citations were issued during this inspection. The facility was found to be in compliance with all applicable regulations.

What type of inspection was this?

This was a complaint inspection. Complaint inspections are triggered when someone reports a concern about the facility to CCLD.

SourceView on CCLD View original report

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Data from CCLD public records. Last updated May 25, 2026. If you believe any information is inaccurate, report it here.

complaint·April 25, 2024