Pacific Gardens at University

Type of visit: Case Management - Licensee Initiated

At approximately 10:00 AM, Licensing Program Analyst, (LPA) Julie Florio arrived unannounced for the purpose of conducting a facility closure inspection. LPA was greeted by staff. Kristine Bernardino, Licensee/Administrator was contacted via telephone and Grace Defeo, House Manager, arrived shortly after. Facility operated as a Residential Care Facility for the Elderly (RCFE). The last day of operation was Wednesday, July 23, 2025. There are no residents present in the facility today. LPA was informed that the facility has begun the application process with California Department of Public Health to become a Congregate Living Health Facility (CLHF). There were a total of four (4) staff present during today's inspection. There were three (3) residents at the time the facility announced it's closure. One (1) of whom passed away, one (1) needed a higher level of care and moved to a facility better suited for that, and one (1) transferred to another facility owned by Licensee/Administrator. The purpose of the inspection is to confirm the licensed services have been discontinued and verify that there are no residents in care. At approximately 10:45 AM, LPA conducted a walk-through of the facility with House manager and inspected all rooms and the exterior of the building. House manager states that today is the staff's last day in the facility. Personal belongings were observed packed up. House manger states that furniture will remain at the facility while a sprinkler system is installed and other construction projects are completed. House Manager states that the facility did not notify the Department of the facility's intent to close, submit a 30-day eviction notice to the Department for approval, or issues a 30-day written eviction notice to the residents and/or their responsible parties as required per Title 22, Division 6, Chapter 8, Article 4: Operating Requirements, Section 87224 Eviction Procedures. LPA explained the requirements to House Manager and provided them with a copy of the regulation. Continued on LIC809C... Continued from LIC809... Closure inspection of this facility has been completed. Facility surrendered the license to LPA. The Department will move forward with the closure process. LPA to finalize paperwork for final closure. No deficiencies cited during today's visit.the state’s words, verbatim · CDSS document, Jul 31, 2025

Type of visit: Case Management - Annual Continuation

At approximately 02:45PM, Licensing Program Analyst (LPA) Deniz arrived unannounced for the purpose of conducting an Annual Continuation and met with Resident Care Coordinator, Mary Grace Caramat Defeo. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and capacity for 6 non-ambulatory residents. Facility has an approved hospice waiver for 2 individuals. Upon arrival, LPA was informed that there were 5 Residents in care. At approximately 03:25PM, LPA reviewed 5 resident records. All clients have medical assessments and care plans updated. Medication records are thorough and contained physician's orders for each resident. However resident R1 did not have current TB test results in file(Technical Violation Given). Medications are centrally stored, and record were in order. Hospice care plans were up to date for each hospice resident. At approximately 04:05PM, LPA reviewed 3 staff records and staff files were containing all required documents per regulation. LPA was presented with proof of current CPR & 1st Aid certification for all staff. Administrator's Certificate for Kristine Bernardino (#7029721740) expires on 12/17/2026 Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducted and documented a disaster drill on 04/09/2025. Continued on LIC809-C... Continued from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Updated Certificate of Liability Insurance No Deficiencies Cited during this Visit. Exit interview conducted. Copy of report discussed and provided to Resident Care Coordinator . Signature on form confirms receipt of documentsthe state’s words, verbatim · CDSS document, Apr 11, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 12:45PM, Licensing Program Analyst (LPA) Deniz arrived unannounced to conduct a 1-Year Required Visit and met with caregiver, Randy Leysa. Licensee/Administrator wasn’t present. Staff called the admin to verify if administrator was available and She wasn’t able to be present during this inspection. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and capacity for 6 non-ambulatory residents. Facility has an approved hospice waiver for 3 individuals. Upon arrival, LPA was informed that there were 6 Residents in care. At approximately 1:25PM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 1:35PM, LPA conducted a walk-though of the facility with Caregiver, Randy Leysa. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a 1 story building with 5 Resident bedrooms, 1 staff bedroom, 3 bathrooms, and common spaces. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to residents. Knifes and cleaning supplies were stored together under the sink in locked cabinet together (Technical Violation given). Hot water temperatures for resident’s common bathroom sink measured 126.6 degrees F which were not found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. It poses an immediate health, safety risk to persons in care. (See LIC809-D page). Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Continued from LIC809... Continued from LIC809... Administrator's Certificate for Kristine Bernardino (7029721740) expires on 12/17/2026. Facility's fire extinguisher was last inspected September 2024. Facility smoke detectors and carbon monoxide detectors were tested and operational. Facility did not conduct their quarterly disaster drill on timely manner. Last disaster drill conducted on 10/14/2024 (Technical Violation given). LPA is unable to complete Annual Inspection. Annual Continuation Inspection visit to be conducted at a later date. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment Exit interview conducted. Copy of report discussed and provided to Licensee/Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Apr 7, 2025

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

LPA Hiratsuka conducted this unannounced annual visit. LPA toured with Caregiver Rowena De Vera. This facility has a fire clearance for six non-ambulatory residents. There is one shared resident room that has a full private bathroom and four private resident rooms. There is one staff room. Backyard was inspected and there is a locked shed in the backyard. LPA reviewed three staff files and three resident files. Common areas and resident rooms were inspected. The following was observed during today's visit: -one resident's bed who is not on hospice has full bed rails. Title 22 regulations does not allow full bed rails on a bed unless the resident is on hospice. -Title 22 regulations requires annual training in multiple subjects. One caregiver has the initial training in 2022, but no training logs other than catheter training in 2023. -Title 22 regulations requires current first aid for all caregivers on duty. One caregiver's first aid was issued on 07/29/2017. No other card was found since then. -One caregiver's training was last completed on 04/15/2023. The annual training has not yet been completed for this month. The following shall be updated and submitted to Community Care Licensing Division by May 1, 2024: -LIC 308 designation of administrative responsibility -liability insurance -LIC 500 facility personnel or staff schedule Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 17, 2024

Allegation investigated: Neglect/lack of supervision resulted in facility not meeting residents care needs.

Licensing Program Analyst Leibert arrives unannounced for the purpose of continuing the investigation of this complaint. LPA toured portions of the facility; reviewed documents and spoke with the staff. This complaint was initiated by medical personnel who expressed concern that the Resident, R1, arrived at a medical facility in a condition that suggests R1's hygiene had been neglected by caregivers prior to admittance. Today it was determined that R1 was sent out from this facility on 12/19/24 for medical reasons and has never returned; R1, subsequent to 12/19, has been hospitalized and in Skilled Nursing Facilities and is no longer a resident of this facility. Based upon statements, the complaint allegation is false and without a reasonable basis since R1 has not resided in this facility since 12/19/2024. Therefore, the complaint is UNFOUNDED. The complaint is DISMISSED. Report Left. Unfoundedthe state’s words, verbatim · CDSS document, Feb 15, 2024 · control 21-AS-20240213095453