Pacific Breeze

Allegation investigated: Staff neglect resulted in a resident sustaining pressure injuries.

Licensing Program Analyst (LPA), Amy Rodgers, conducted a visit to deliver findings regarding the above mentioned allegation. LPA met with Licensee, Monica Siharath. During the investigation, the facility was toured, records were reviewed, and interviews were conducted with staff, hospice personnel, and outside sources. On January 21, 2026, Community Care Licensing (CCLD) received a complaint alleging that staff neglect resulted in resident #1 (R1) sustaining a pressure injury. R1’s medical records indicated R1 was non-ambulatory, dependent on staff for repositioning, and receiving hospice care at the time the pressure injury developed. Unsubstantiated (Continued from Lic9099) Facility documentation showed R1 required total assistance with activities of daily living, including transfers, toileting, repositioning, and personal hygiene. Several staff interviews confirmed R1 needed frequent redirection and often resisted care due to cognitive decline On the date the injury was discovered, staff documented a wound to R1’s sacral area and notified hospice. Hospice orders indicated wound care treatment was to be provided by the hospice agency, with the facility responsible for implementing supportive measures such as regular turning and monitoring for changes. Department Interviews revealed staff were providing care and communicating changes to hospice; however, documentation of repositioning was inconsistent. Turning logs provided during the investigation did not consistently show two hour repositioning intervals, and time specific entries were missing on multiple dates. Further staff interviewed revealed that repositioning occurred as needed, but the lack of documentation made it difficult to verify frequency or consistency. Department review of hospice records revealed R1 was at high risk for skin breakdown due to advanced age, immobility, poor intake, and terminal diagnosis. Department interviews with hospice personnel revealed the wound progressed despite interventions and was not uncommon given R1’s clinical condition. Department records reviewed confirmed R1 received ongoing wound care and had regular evaluations by the hospice nurse. During the investigation, statements and records reviewed did not demonstrate that the pressure injury was more likely than not caused by staff neglect. Although documentation gaps were noted, evidence did not establish that the injury occurred due to lack of care or failure to follow medical directives. Based on the totality of information collected, the allegation is deemed unsubstantiated. An exit interview was conducted with Licensee, Monica Siharath over the phone , and a copy of this report, along with Licensee Rights (LIC 9058), was provided to Caregiver Reymundo Garvida, whose signature below confirms receipt.the state’s words, verbatim · CDSS document, Sep 19, 2026 · control 08-AS-20260121114736

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Caregiver Reymundo Garvida. LPA alps spoke with Licensee Monica Siharath over the phone. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, of which one (1) may be bedridden in room #1. Hospice waiver approved for four (4) residents. LPA accompanied by Caregiver Garvida toured the interior and exterior of the facility and inspected each room. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on premises. Emergency lighting, and facility telephone were all in working order. Fire extinguisher(s) were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA reviewed facility records. During review of resident records LPA observed that Resident #1 (R1) did not have a tuberculosis test in the file. Two technical violations and two technical assistance were issued per California Code of Regulations, Title 22 (refer to the attached LIC LIC9102). and an exit interview was conducted with Licensee Siharath over the phone. A copy of this report and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to Reymundo Garvida.the state’s words, verbatim · CDSS document, Sep 19, 2026

The state marks this report as 6 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Licensee Monica Siharath. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, of which one (1) may be bedridden in room #1. Hospice waiver approved for four (4) residents. During today’s inspection, there were five (5) residents in care. LPA accompanied by Licensee Siharath toured the interior and exterior of the facility and inspected each room. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on premises. Per Licensee Siharath, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher(s) were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. [Continued on LIC809-C] LPA reviewed facility records. During review of resident records LPA observed that Resident #1 (R1) did not have a tuberculosis test in the file. One deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). A plan of correction was jointly formulated, and an exit interview was conducted with Licensee Siharath, to whom a copy of this report, LIC809-C, LIC809-D and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.the state’s words, verbatim · CDSS document, Sep 18, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ryan Fulton conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Reymundo Garvida. Administrator Monica Siharath later joined the inspection. The facility's license shows a maximum capacity of six (6) residents, of which Six (6) may be non-ambulatory. During today’s inspection there were six (6) residents in care. LPA and Reymundo Garvida toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all of which are safely stored. Cooking/dining equipment and utensils were present. Toxic chemicals/poisons were locked and inaccessible to Resident. Medications were labeled, as required, and stored in locked areas. The facility’s ambient internal temperature was compliant. Hot water temperature at taps accessible to clients were all compliant: Kitchen sink was 113.2 F; bathroom #1 sink was 116.3 F and bathroom #2 sink was 114.4 F. No pools or bodies of water exist on the premises. Per licensee, no firearms or ammunition are kept at the facility. Carbon monoxide/Smoke detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher was serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. No deficiencies were cited during the inspection.the state’s words, verbatim · CDSS document, Jun 12, 2024