Pacifica Home Care III

Type of visit: Required - 1 Year

On May 18, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. Licensee (LI) Luis Lucero was notified via telephone and later arrived to assist with the inspection. LPA observed that Luis Lucero has a valid Administrator certificate which expires on July 18, 2027. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, of which five can be bedridden, and has a hospice waiver for two. The facility is a single story home which consist of five resident bedrooms, four resident bathrooms, a living room, a dining room, a kitchen, a den, and an attached two car garage. On today's visit, LPA observed there are no residents currently in care and the facility is vacant. LPA, accompanied by the LI, conducted a tour of the interior and exterior portions of the facility. LPA inspected the five resident bedrooms and observed them to be free of any hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA inspected the four resident bathrooms and observed them to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. LPA inspected all other common areas such as the kitchen, the dining room, the living room, the den, and observed it to be free of any hazards. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA also observed the exterior to also be clear of any obstructions or hazards. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed the perimeter gate of the facility to be self latching and can be opened in an evacuation. There are no bodies of water on the premises. Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Licensee Luis Lucero and a copy of the report was provided at time of visit.the state’s words, verbatim · CDSS document, May 18, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Kimberly Lyman made an announced visit to conduct a pre-licensing inspection. LPA identified herself and discussed the purpose of the visit with Licensee/ Administrators Luis Lucero and Jeffrey Gardner. An initial application to operate a Residential Care Facility for the Elderly was submitted to Community Care Licensing on 07/05/2024 for a capacity of five non-ambulatory and one bedridden resident. Upon entry, facility appears clean, safe and sanitary. Facility has all required postings including personal rights, admission agreements and theft and loss policy. Administrator Luis Lucero has an administrator certificate expiring on 07/18/2025. LPA Lyman along with Licensee/ Administrators Lucero and Gardner toured the facility at 7:50 AM and observed the following: Structure: Facility is a one story, five bedroom, four bathroom house as well as a den with a tan exterior and attached garage. There is an enclosed front patio with seating for residents. Living Room/ Dining Room: Adequate seating is available in the dining room and living room. Bedrooms Residents: Rooms will be single and double occupancy. All rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Exit doors have auditory exit alarms. Linens & Hygiene Supplies: Facility has ample bedding and towels in supply. Bathrooms: All resident bathrooms have a working toilet/ wash basin as well as grab bars and non-skid surface in the shower. Emergency Phone Numbers and Exit Plan: Posted in the entrance of the facility. Food Service: Facility has a small amount of food on-site due to no residents currently residing at facility. Facility to obtain perishables and non-perishables upon licensure. Smoke Detectors: Smoke detectors/ carbon monoxide detectors are centrally wired and were tested operational. Fire extinguishers are fully charged. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. CONTINUED ON LIC 9099C DATED 05/09/2025 Toxins/ Sharps: Facility has secured areas for toxins and sharps. Water Temperature: Tested and recorded between 111 and 114.4 degrees F. in facility bathrooms. Emergency Supplies: LPA observed ample emergency food and water as well as a posted emergency disaster plan. Facility is equipped with solar power as well as backup battery for emergencies. LPA observed night light in facility hallway. Medications, First-Aid Kit & Book: First aid kit observed contained all required items including tweezers, scissors and thermometer as well as a first aid manual. Medication to be stored in a locked cabinet. Facility will use a medication administration record. Resident & Staff File: Records are to be stored in a secured file cabinet. Reading Material, Games, and Equipment: LPA observed a sample activity schedule with activities such as games and exercise. Backyard: LPA observed a clean backyard with ample shaded seating for residents. Fire Clearance: Approved for five bedridden and one ambulatory resident on 08/05/2024. Component III conducted during the visit. Facility is ready to be licensed. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 9, 2025